LIBRARY OF CONGRESS. 

€liap.-^— Copyright No, 



Shelf 



,yE2 



UNITED STATES OF AMERICA. 



n 



A COURSE IN 



SURGICAL OPERATIONS 



FOR 



Veterinary Students and Practitioners 



BY 



W. PFEIFFER, 

Assistant in the Surgical Clinic of the Veterinary High School in Berlin, 
AND 

W. L. WILLIAMS, V.S., 

Professor of Surgery in the New York State Veterinary College, 
Cornell University, Ithaca, N. Y. 



With an Introduction by PROF. DR. FROHNER. 

With 42 Original Illustrations. 



W. R. Jenkins, 
New York. 



Balliere, Tindall & Cox, 

London, 

1900. 



44067 



(lib*>4»« y of Conyre««{ 

SEP ^ 19C0 

jDofyWsb! --try 

SECeNO COPY* 1 
OROtS DIVISION, ^ 



Copyright 1900, B^ 
W. L. Williams, 



7457? 



Press of Andrus & Church, 
Ithaca, N. Y. 



INTRODUCTION TO DR. PFEIFFER'S OPERA- 
TIONS-CURSUS. 



The publication of a brief introduction to operations has 
become a pressing need in the operative exercises which 
hav^e been conducted jointly by the author and the under- 
signed, during the winter semester in the (Berlin) Veterinary 
High School. 

The submitted guide is intended primarily to serve as a 
catechism to the .student in the technique of operations and 
to support the oral explanations in the course by text and 
illustration. Consequently only the most difficult and com- 
plicated, to an extent the instrumental operations, are de- 
scribed as briefly as po.ssible and fundamentally from the 
standpoint of technique. Designedly also only one method 
of operation is described, as a rule, namely, that one which 
from the standpoint of personal clinical experience has 
proven the best, as for instance, castration by the method 
of torsion, the Bayer operation for quitter, our method of 
resection of the tendon of the flexer of the os pedis, etc. 

The multiplication of methods confuses the beginner 
readily ; as an important lesson in operative instruction, the 
student must become thoroughly acquainted, among other 
things, with 07ie method with which he becomes .so familiar 
that he can rely upon it with perfect trust in practice From 
this standpoint also the needs of the veterinary practitioner 
are met, who find 'in the same, besides the most important 
operations on the hor.se, also .some in cattle (amputation of 
the claws) and dogs (entropium operation). 

In order to confine the handbook within proper limits, the 
minor operations (sutures, cautery, catheterization, etc.), the 



IV 



Introd2iction to Dr. Pfeiffer's Operatio7is-Cursus. 



instruction regarding instruments and bandaging, as well as 
the methods of restraint, have not been considered. In the 
same way the indications for performing the described 
operations are relegated to the lecture and the text books 
of operative surgery. 

Finally, we beg to acknowledge the estimable manner in 
which the illustrations have been made from the original by 
Mr. Max Fischer, student, Berlin. 

PROF. DR. FROHNKR. 

Berlin, September, i8gy. 



PREFACE TO ENGLISH EDITION. 



Professor Frohner's foregoing introduction to Dr. PfeifFer's 
manual explains fully its object. Having found it essential 
to effective instruction in surgical technique, that the student 
should have extensive laboratory experience in the more in- 
tricate surgical operations (the proper performance of which 
perforce, includes training in methods of confinement, 
anaesthesia, antisepsis, hemostasis, suturing, bandaging, 
etc.,) we have conducted a course in operations upon 
anaesthetized animals, which are destroyed while yet un- 
conscious, b}^ which the student becomes familiar with the 
various operations under the normal conditions in the living 
animal. 

The non-existence of a satisfactory manual in English 
induced us to ask Dr. Pfeiffer's permission to translate and 
use, so far as might suit our purposes, his Operations-Cursus, 
to which he readily assented, and in which his publisher, 
Mr. Richard Schoetz, concurred. It is, therefore, largely 
due to their courtesy and liberality that we are enabled to 
present to English speaking veterinary students and prac- 
titioners this little manual, accompanied by the worth given 
it by the valuable experience of Prof. Dr. Fiohner and Dr. 
Pfeiffer. 

With a view to enhancing the value of the work to British 
and American students, we have added some of the more 
recent, largely distinctively American, operations which we 
deem of sufficient value to warrant insertion in such a work. 
To this end, we have added cunean tenotomy, digital neurec- 
tomy, Bossi's neurectomy of the peroneal nerve, McKillip's 
operation for exploring the pharynx, Eustachian tubes, etc. 



vi Preface to English Edition. 

(staphylotomy.) Merillat's operation for "roaring" 
(arytenoidrraphy) and our own operations of trifacial 
neurectomy (for involuntary shaking of the head), repulsion 
of molars, irrigation of the trachea, caudal myotomy (for 
curved tail), caudal myectomy (for gripping of the reins), 
and vaginal ovariectomy. 

In order to keep the volume of the work within bounds, 
we have omitted, not without regret, Dr. Pfeiffer's extirpa- 
tion of the submaxillary lymph glands, subcutaneous caudal 
myotomy (nicking), and castration by torsion. The chap- 
ters and illustrations on trephining have been greatly modi- 
fied, and we have occasionally introduced suggestions in [ ]. 
Most of the illustrations were supplied by Mr. Richard 
Schoetz, Berlin, from Dr. Pfeiffer's Operations-Cursus, the in- 
strument figures were provided by John Reynders & Co., the 
remainder are from original drawings by Dr. E. Merillat, and 
Mr. C. F. Flocken, veterinary student : the chapter on 
Staphylotomy was contributed by Dr. M. H. McKillip, and 
that on Arytenoidrraphy by Dr. L. A. Merillat, to each of 
whom our indebtedness is iieartily acknowledged. 

W. L. WILLIAMS. 
Cornell University, igoo. 



CONTENTS. 



Operations on the Head : 

Extraction of Teeth i 

Repulsion of Teeth 4 

Trephining of Frontal Sinuses 7 

Trephining of the Maxillary Sinuses 9 

Trephining of Nasal Passages 11 

Ligation of Parotid Duct 12 

Entropium Operation 14 

Staphylotomy 15 

Trifacial Neurectomy 16 

Operations on the Neck : 

Opening of the Guttural Pouches 18 

Tracheotomy 21 

Intra-tracheal Irrigation 23 

Arytenoidrraphy 23 

Intravenous Injection 27 

Phlebotomy with Fleams 29 

Phlebotomy with Lancet 31 

Phlebotomy with Trocar 31 

Ligation of the Carotid 32 

CEvsophagotomy 34 

Operations on the Trunk and Genital Organs: 

Puncture of the Chest 36 

Puncture of the Intestine 37 

Subcutaneous Myotomy for Curved Tail 39 

Caudal Myectomy for Gripping of the Reins 41 

Amputation of the Tail 42 

Urethrotomy 44 

Amputation of the Penis 47 

Vaginal Ovariectomy . 48 



viii Contents. 



Operations on the Extremities 



Tenotomy of the Flexor Tendons of the Foot 54 

Tenotomy of the Lateral Kxtensor of the Foot (Stringhalt 

Operation) 1 56 

Tenotomy of the Cunean Branch of Flexor Metatarsus 

(Spavin Operation) 58 

Plantar Neurectomy 59 

Digital Neurectomy 62 

{Median Neurectomy 64 

Ulnar Neurectomy 67 

Sciatic Neurectomy 69 

Anterior Tibial Neurectomy 71 

Resection of the Lateral Cartilages of the Os Pedis 73 

Resection of the Tendon of the Flexor of the Os Pedis 77 

Amputation of the Claws of Ruminants 79 

Appendix : 

Bayer's Sutures 82 



OPERATIONS ON THE HEAD. 

EXTRACTION OF TEETH. 
t Fig. I and 2. 

Instriirnents. Extracting forceps acting as a lever of the 
second class for the Miiolars, extracting forceps acting as a 
lever of the first class for the pre-molars (the forceps for the 
superior pre-molars are bent), fulcra of various sizes, mouth 
opener with abundant lateral working room, reflecting lamp, 
exporteur forceps, toothpick, splinter forceps. 

Techyiiqtie. With quiet horses extraction ma}^ be carried 
out with the animal standing, the horse being backed into a 
corner. Resistant animals must be laid down. After the 
application of the mouth speculum the diseased teeth must 
be properly identified by manual exploration, it must be 
determined whether tliey are alread}^ loose or if they have 
an abnormal direction (for example, are misdirected toward 
the cheek), the condition of the neighboring teeth, etc. 
These investigations can be rendered easier in case of insuf- 
ficient daylight ))y illuminating the mouth cavity with the 
reflecting lamp [or still better, by means of an incandescent 
electric lamp]. After the partially chewed food pellets have 
been removed with the toothpick or the fingers, count the 
teeth from before backward until the diseased tooth is 
reached, by passing the fingers along their median or inner 
sides. For the extraction of the molars, extracting forceps 
acting on the principle of a lever of the second class with 
fulcra are used, the latter having a plane and a convex 
surface. 

The pre molar forceps are on the principle of a lever of the 
first class, those for the superior pre-molars are bent on the 
flat, becau.se if they were .straight the forceps handles 
would strike against the superior incisors and hinder the 
deep fixation of the forceps. 



Extraction of Teeth. 



The next point is, to fasten only the diseased tooth with the 
forceps and to so appl}' them that the jaws of the same reach 
at least to the gums. For this purpose draw the tongue out 
from the angle of the mouth as far as possible on the sound 
side, introduce tlie hand into the mouth, and place the index 
finger on the posterior border of the diseased tooth, while 
with the other hand push the open forceps backward upon 
the tooth row until tliey reach the finger and grasp the 
crown of the affected tooth with the forceps jaws. The free 




Fig. I. — Extraction of the first inferior molar, viewed from within ; 
sagittal section through the walla of the oral cavity. 

hand is now withdrawn from the moulh, the forceps handles 
are grasped with both hands, and the tooth fang loo.sened in 
its alveolus by maintaining a gentle lateral movement, until 
the tooth evidently yields. The fulcrum is then carried in 
with one hand while with the other the forceps are main- 
tained in the original position, and placed as far in as possi- 



Extraction of Teeth. 3 

ble in such a manner that the plane side rests upon the 
grinding surface of the teeth. The fulcrum must be held 
firmh' between the teeth and forceps in order that it shall 
not glide forward. The operator now lifts the tooth fang 
out of the alveolus in such a way that in the inferior molars 
the forceps handles are pressed downwards, the superior 
molars upward. In this way, while the tooth fang gradually 
comes out the forceps glide over the convexity of the fulcrum 
and favors the oossibilitv of tlie tooth drawino- out in the 




Fig. 2. — Extraction of the second superior premolar, viewed from 
within ; sagittal section through the walls of the oral cavity. 

direction of its fixation. In case of the last molars as a rule 
the forceps push against the oppo.site row of teeth of the 
same side before the tooth is completely withdrawn. In 
this case the tooth, which is now loose in the alveolus, is 
either grasped more deeply by the forceps or is removed 
when this is no longer possible with the exporter or with the 



4 Rf^mlswm #/" Teetk. 

hand. [In some young horses we* have found it necessary 
to cut the tooth in two in its middle with tooth cutting for- 
ceps in f3fr^ss: to remove it]. With the pre-molar forceps the 
fiilcram is placed beneath the extension in front of the jaws 
<tf the foiceps- 

This extensioa lests opcm the grinding surface behind the 
diseased tooth and acts in such a manner that the pre-molars 
can be withdrawn from before backward in their line of 
direction. For the extraction of the inferior pre-molars the 
forceps handles must be pressed upward, in the superior 
downward. Satisfactory extratrtion can only occur after the 
disappearance of resistance is recognized, accompianied by a 
crefHtant sonnd due to the entrance of air into the aveolus. 



""—^ CTrkv '■^" 



x-ig. 5- 

Imsirmmumis. Razor, amvex scalpels (2^^, trephine, bone 
gouge, bone gouging forceps, light bone chisel, heavy bone 
chisel, mallet, compression forceps, curette, heavy tooth 
punch coDca\£ at distal end, scissors, needles, thread, ab- 
scHbmt cotton, antiseptic gauze, extracting forceps, heavy 
splinter forceps, dressing forceps, trachea tube, tenacula, 
m^al probe, mouth speculum. 

Teduaqme. Secure in lateral recumbent position, produce 
anaesthesia, and if sinuses are involved in a way to make 
possiUe the inhalation <^ purulent matter, blood or other 
liquid, prepare for tracheotomy « which see) and perform it 
in time to av>ert any danger. Shave the region over the 
affected tooth and trephine by the method described in the 
following chapter down upon the fang of the tooth, or in 
case <^ odontomes, upon the tumor. In case of tooth fistula, 
the identity of the affected member is best ascertained by pass- 



R^misam >if Teeth 




r 



F5G. 5.— 3L«i 



^U.I.2XV(U. v/1^ 






6 Repulsion of Teeth. 

ing a metallic probe through the fistula against the diseased 
fang while one hand is inserted in the mouth and determines 
the location of the probe. In trephining be careful to avoid 
injuring adjoining teeth. Control homorrhage completely 
after removal of the osseous disc and then enlarge the open- 
ing with forceps, gouge or chisel, until the entire width of 
the tooth fang is laid bare. Insert a sharp scalpel at the 
oral side of the trephine opening between the periosteum 
and superposed soft tissues and with the left hand in the 
mouth to act as a guide, push the scalpel along the perios- 
teum until it enters the mouth and extend this incision 
backward and forward until the .soft tissues are completely 
detached from the alveolar wall over the eijtire area of the 
affected tooth. With a light, narrow bone chisel, cut away 
the entire external bony plate of the alveolus, the full width 
of the tooth from the lower or oral- margin of the trephine 
wound into the oral cavity. The chi.sel is to be so held that 
the outer edge is inclined from the tooth, otherwise the im- 
pact of the chisel may loo.sen the alveolar wall from the ad- 
joining tooth. Drive the chisel for a short distance alter- 
nately on each side and thus avoid the splitting off of large 
sections of bone which might extend to the neighboring 
alveoli. With the gouge and chisel remove all remnants of 
bone covering the external or lateral side of the tooth. The 
soft tissues over the region are left undisturbed except the 
disc removed for trephining. When the tooth is bared the 
punch may be placed against the end of the fang and the 
tooth driven b}^ a few firm, quick blows into the mouth 
where it is grasped by forceps or the hand and withdrawn. 
If this be impracticable or unsafe, comminute the tooth or 
tumor to the desired degree with the heavy chisel and ham- 
mer, and remove the pieces with gouge or forceps. Be 
careful to remove all fragments. Cleanse and disinfect the 
alveolus and tamponade with iodoform gauze or cotton, and 
dre.ss daily. In chronic fi.stula of an alveolus after removal 
of a tooth by other means, remove the external bony plate 
in the manner described, as if for removal of the tooth. 



Trephining the Frontal Sinuses. 7 

TREPHININCx THE FRONTAL SINUSES. 
Fig. 4. 

InstriinieJits Razor, scissors, convex scalpels, compres- 
sion forceps, tenacula, probe, trephine, bone scraper, curette, 
gouge, bone gouging forceps, hammer, chisel, disinfection 
material, absorbent cotton, long curved uterine dressing 
forceps, bone screw, lens shaped bone knife, probe pointed 
scalpel. 

Techniqjie. Shave or clip the hair from the region of the 
frontal bone at a level with the superior border of the orbital 
cavit}^ and disinfect the area carefulh'. With a heav\^ 
convex scalpel make a circular incision, as large as the 
diameter of the trephine, the median border of which shall 
be I cm. from the median line of the face, directly through 
the skin, subcutem and periosteum, seize the isolated area 
with a tenaculum and with the scalpel or bone scraper 
detach the periosteum from the bone and remove in one 
piece, the skin, subcutaneous tissue and periosteum. Con- 
trol hemorrhage. With the centerbit extended place the 
trephine accurately upon the denuded area, perpendicular to 
the surface of the bone, and by revolving it to and fro force 
the centerbit into tlie bone and continue until the trephine 
has cut well into the bone, when the centerbit should be 
withdrawn and the operation continued, being careful to 
maintain, the trephine perpendicular to the bone. The 
operation is facilitated by grasping the trephine between 
the thumb and fingers of the left hand, constituting a con- 
duit in which it can glide back and forth. The pressure 
under which the sawing is carried out must not be too great. 
When the bony plate which has been sawed around begins 
to loosen, the bone screw is screwed into the centerbit open- 
ing and the piece of bone is broken out, or it is pried out 
with the bone gouge or chisel. Uneven edges of bone 
should be smoothed with the lens-shaped knife. The ab- 
normal contents of the frontal sinus can now escape or be re- 



8 



Trephiniiig the FroJital Sinuses. 



moved with curette, forceps and scissors, and the cavity irri- 
gated with an antiseptic fluid. The frontal sinuses are in 




Fig. 4. — Trephining facial sinuses. A, Trephining frontal sinus ; B, 
trephining nasal fossa ; C, trephining maxillary sinuses ; S, dia- 
grammatic outline of maxillary sinuses ; T, diagrammatic outline 
of inner face of the maxillarv turbinated bone. 



Trephining the Maxillary Sinuses, 9 

inunicatioii with the superior maxillary sinuses and the 
superior turbinated bone of the saine side so that indirectly 
the irrigating fluid can escape through the nasal opening by 
way of the maxillary sinus or the injured superior tur- 
binated bone. In order to prevent aspiration of the fluid, 
which is generally purulent, and to facilitate its escape, irri- 
gation must be carried out with the head elevated and 
flexed. An artificial connection between the frontal sinus 
and the nasal passage can be made by passing the probe in 
a downward and inward direction, forcing it through the 
thin bony plates and mucous membrane of the turbinated 
bone and then by means of the probe pointed scalpel cut an 
opening about 2 cm. in diameter. In order to prevent aspi- 
ration into the lungs, the animal must be allowed to get up 
immediately, or if under anaesthesia, a tampon trachea tube 
should be inserted in the trachea. In case of severe hemor- 
rhage, the cavit}^ can be tamponed for twenty-four hours 
with a long strip of gauze one end of which hangs out of the 
wound and the tampon fixed in position by two sutures 
passed through the lips of the wound. The operation can 
be carried out in the standing position if the animal is quiet. 



TREPHINING THE MAXILLARY SINUSES. 
Fig. 4. 

Technique. Shave the skin over the superior maxillary 
bone on the median side of the zygomatic ridge. Make a 
circular incision as large as the diameter of the trephine 
through the skin, subcutem and periosteum down to the 
bone, the lateral or outer margin of the circle being about 
15 mm. nasalwards from the zygomatic ridge toward the 
lateral border of the levator labii superiorus muscle and 
place the trephine 7 cm. above the lower end of the zygo- 
matic ridge. The trephining is carried out as described 
above. It must be remembered that the superior maxillary 



lo Trephining the Maxillary Sinuses. 

bone increases in thickness toward the zygoma, so that the 
instrument muit be held at an acute angle to the vertical 
plane of the zygoma. At the point directed the trephine 
opening lies partly on either side of the partition between 
the maxillary sinuses so that both cavities are simultane- 
ously opened. This partition between the two sinuses varies 
in location with the age of the animal and in disease is fre- 
quently partially or wholly destroyed, so that in practice 
the division is frequently ignored. Should the partition 
not break out with the trephined disc of bone it must be cut 
awa}^ with the hammer and chisel or with bone gouging 
forceps. The inferior smaller maxillary sinus communicates 
through an elongated slit with the inferior turbinated bone, 
the superior larger maxillary sinus communicates directly 
with the nasal passage by means of the special naso-sinusal 
opening, so that the irrigation fluid can here also escape 
through the nasal passage. Care must be exercised to not 
injure the superior maxillary division of the tri-facial nerve 
in its course through the maxillary sinuses, enclosed in 
its bony sheath. This bony conduit is, in rare cases, 
obliterated by pressure (odontomes) leaving the nerve 
stretched across the cavity as a white, nacrous cord, in- 
tensely sensitive. This neural conduit divides the maxillary 
sinuses into inner or median and outer or lateral compart- 
ments in such a way that trephining alone affords incomplete 
and unsatisfactory drainage. If a tooth has been repulsed 
ample drainage may be afforded into the mouth. Otherwise 
locate by digital exploration the lower border of the median 
or inner compartment of the sinus and make a second tre- 
phine opening over that point, insert the index finger of one 
hand through the trephine opening and rest it against the 
inner or median wall of the sinus formed by the maxillary 
turbinated bone, while with the other hand introduce the 
long curved uterine dressing forceps through the nostril up 
the nassal passage until the end of the forceps is felt with the 
finger, break or cut through the intervening wall and push 



Trephining the Nasal Passage. ii 

the end of the forceps into the sinus. Introduce a tapering, 
antiseptic piece of cheese cloth through the trephine wound, 
grasp it with the dressing forceps and draw it out until the 
lower end appears at the nostril while the upper end hangs 
from the trephine wound. The strip of cheese cloth may 
also be inserted by means of a probe, after the opening has 
been made. Arm a long probe with a strong thread, insert 
the probe through the trephine opening and the wound in 
the turbinated bone and pass it out through the nostril, 
attach the cheese cloth to the end of the thread and draw it 
into the wound by pulling upon the probe. Control hemor- 
rhage during operation : a. From skin, by compression or 
ligation, b. From intre-osseous vessels, by plugging with 
a conical piece of wood pushed into the vascular opening 
or by absorbent cotton pushed into the channel with the 
point of a needle or tenaculum, c. From the sinuses or 
wounded turbines by packing with cheese cloth or cotton. 

Remove tampons after 24 hours and renew for a second 
day if required. Leave all wounds open and irrigate with 
tepid antiseptics. 

TREPHINING THE NASAIv PASSAGE. 

Fig. 4. 

Technique. The trephining is carried out by the method 
described, in the region of the nasal bone, close by the me- 
dian line of the face and according to indications either 
above or below a perpendicular line drawn from the lower 
end of the zygoma to the nasal arch. The operation must 
be immediately against the median line since otherwise the 
maxillary sinuses are easily opened or the superior turbine 
wounded at the point of insertion. Special care is also 
necessary in removing the disc of bone, because the superior 
turbine lies directly beneath it and bleeds profusely when 
wounded on its dorsal aspect. In all cases after trephining 
about the nose or face where inhalation of blood, septic 



12 



otomT 



■jfr'rr cf tiu PmrwUd Daui, 

-^ liable to occur, perform trache- 
T basic operatioii and retain the 
. r : :s past. 



.ATION OF THZ PARO: 



.i^^ ^i".'!! ir.-i .- ^ 



pointed scalpeL ten: 

xieedle holder, needfcs, thread, probe, absorbent cotton, 

cmette. 

Tfflnifni^ In case of salivary fisinla, divide the fistnkMis 





Fig - 



opeirmg in the ski:: --t 5v.';z:'rnt lissnes toward the 
paiodd gland with a probe poiated scalpel and lay the 
parotid duct finee for a distance erf* fixMn i to 2 cm. on the 
proxim al side kA the fistula. If the fistula has its location 
on the side of the cheek, cast the horae and shave and dis- 
infect the vascular r^;ioa of the inferior maxilla. When 
the opeiator glides a finger over the vascular region from 
befere backward tnere is felt a resi^4ant cord, the external 




«3 



tiheoEsI backer €if tkt 

4 

kigfa'and cattily tikro^^ tks ibU. 
thre tissae wiCb a poor of fixceps 32a€ 





F^. 



atehrb^knid tike ex: 



boKdercftke 

of saliTarr calciili wi _ . - _ ^_ _ - 

BMMi^ mad CTStic dilatdoit of tihe p«o(ki dtzct. mace toe 
zt Ae afibrte* tx tb« pazocai 

aad after renoval oi calc^- ^e the wotnol 

hy BKansof tmtfistmal siitefe kk sack a war dbcac t^ie extn^ 
«d sarftce? of the £cp^ of tike v«M»d[ tK tbe vati of tihe ^Kt 
are bnMngltt in e^^ttsct er ligpaie tike ifiact on tike pnodenal 
side of tike poiat ion. L%afemi is u t r— yfi \m if Tij 

a strott^ >v.^ ..iread beknd tike ^^kkt^ pwl V^r 
of a cnnred aeedte. carrrtng: tt xroaaiii tke 



1 4 En tropin m Opera Hon . 

duct and tying with a surgeon's knot. The parotid duct 
can also be previous!}^ split and an internal wound made at 
the point of ligation. Close the skin wound by means of a 
continuous suture like an overcasted seam and cover the 
operative surface with iodoform collodion. 



ENTROPIUM OPERATION. 

Fig. 7. 

Instruments. Razor, scissors, mouse-toolh forceps and 
ligation forceps, needles, thread, 3 per cent, borax solution. 

Technique. Confine the animal in the lateral recumbent 
position [or in the horse operate standing] shave tlie skin 
of the affected e3'elid and disinfect. Grasp the skin of the 
ej^elid midway between the inner and outer canthus either 




Fig. 7. — Entropiiim operation on the superior and inferior eyelids 

of the dog. 

with fingers or mouse-tooth forceps and elevate a fold of 
the skin parallel with the border of the eyelid to such a 
height that the inverted eyelid assumes its normal position. 
Pass one finger into the conjunctival sac to make sure that 
the conjunctiva is not drawn into the skin fold. The fold 
is then clipped off with the scissors immediately below the 
forceps. Between the border of the lid and the border of 
the wound the skin must be left intact for at least .5 cm. 
Bleeding vessels are ligated and the wound closed b\^ means 



Staphylotoviy . 1 5 

of interrupted sutures. In the dog a funnel shaped hood 
can be applied after the operation, in horses a flap can be 
applied made from sev^eral thicknesses of soft gauze [or 
generally left uncovered with safet3\] 



STAPHYLOTOMY 



[McKillip's operation for making a manual exploration of the Eu- 
stachian tubes, guttural pouches, pharynx and posterior nares, and for 
operations upon those structures.] 

Instruments. (a) A ratchet mouth speculum. (d) A 
short, curv^ed, probe pointed bistoury equipped with a fer- 
rule to fit the middle finger. 

Restraint. The patient is cast and secured in the laterstl 
(costal) recumbent position and the head is turned upward. 

Technique. The mouth speculum is adjusted and opened 
as far as is possible ; the tongue is protracted with the left 
hand while the right containing the knife on the middle 
finger is passed carefully through the fauces until the knife 
hooks over the posterior border of the soft palate. The 
knife is then gently drawn forward so as to make an in- 
cision along the median line of the soft palate from the pos- 
terior border to its attachment on the palatine bone. The 
hand is then retracted and the speculum removed for a few 
minutes to permit the patient to rid its throat of the slight 
hemorrhage and mucus that might have accumulated. 

Readjusting the speculum as before the right hand is 
again passed through the fauces and now that the palate is 
divided a digital exploration will perfectly reveal the pres- 
ence of any abnormality in the region. 



1 6 Trifacial Neurectomy . 

TRIFACIAL NEURECTOMY. 

(For relief of involuntary shaking of the head.) 

Fig. 8. 

Instruments. Razor, scissors, convex scalpel, tenacula, 
aneurism needle, compression arter}^ forceps, needles, thread, 
absorbent cotton, a stout piece of muslin 12 cm. square. 



'"1^^^- 



M 
\ 

\ 
\ 
\ 


1 
1 

1 
1 

1 


\ 


1 
f 
1 
1 ^^ 




^ 





Fig. 8. — Trifacial neurectomy. M, Depressed levator muscle of the 
upper lip ; A'', supermaxillary division of the trifacial nerve at 
the infra-orbital foramen. 

Techniq2ie. Secure in lateral recumbency and produce 
anaesthesia. Remove the halter, bridle or other head- 
gear. Shave and disinfect an area 8 to 10 cm. square over 



Trifacial Neurectomy. 17 

the infra-orbital neural foramen. Locate by touch the in- 
fra-orbital foramen below the levator labii superioris pro- 
prius muscle and displace the latter downwards (toward the 
inferior maxilla) until the foramen can be felt above the 
muscle. With the muscle displaced begin an incision, 
above the levator muscle in order to avoid the branches of 
the glosso-facial vessels below it, i cm. above the foramen 
and carry it downward directly over the middle of the 5th 
nerve a distance of 5 or 6 cm., cutting through skin, sub- 
cutem and the levator labii superioris alaque nasi muscle, 
laying bare the nerve at its emergence from the foramen. 
Let an assistant hold the lips of the wound apart and the le- 
vator muscle downwards with two tenacula, dissect away 
the connective tissue surrounding the nerve until the latter 
is clearly defined, pass the aneurism needle beneath the 
nerve from above downwards being specially careful to in- 
clude the uppermost or dorsal twigs, and passing a curved 
probe pointed scalpel or one blade of a pair of scissors 
underneath it, divide the nerve at the foramen, grasp the 
free end with compression or other forceps and excise a 
piece at least 3 cm. long including all branches. Clean.se 
the wound, sprinkle with iodoform and close with continu- 
ous sutures. Place the square piece of muslin centrally 
over the wound and fix it securely to the skin by means of 
a strong suture at each corner, in order to protect the wound 
while the other nerve is being cut. Turn the animal to the 
opposite side and repeat the operation on the other nerve 
except the square piece of muslin which is here unneces- 
sary. As soon as the animal stands, remove the protective 
piece of muslin from the first wound, disinfect wounds and 
leave undisturbed to heal by primary union. Avoid halter, 
bri'dle or other fixtures which might injure the wounds 
after operation. 



OPERATIONS ON THE NECK. 

OPENING OF THE GUTTURAL POUCHES. 

Fig. 9. 

Instruments. Razor, scissors, convex pointed, and 
straight probe pointed scalpels, mouse-toothed and ligation 
forceps, tenacula, probe, trocar, curette, drainage tubing, 
needles, thread, absorbent cotton. 

Techuque. i. Viborg' s method. The operation is pos- 
sible on the standing animal. By extending the head and 
compressing the jugular vein there is brought out the tri- 
angle immediately behind the posterior border of the in- 
ferior maxilla and beneath the parotid gland comprised be- 
tween the posterior angle of the inferior maxilla the ter- 
minal tendon of the sterno-maxillaris muscle and the ex- 
ternal maxillar}^ vein. In this so-called Viborg's triangle 
after the removal of the hair and the disinfection of the 
.skin which is maintained stretched, make a 5 cm. 
long incision through the skin and .skin muscle im- 
mediately beneath the aforementioned tendon and paral- 
lel to it. It can also be done when tense swelling is not 
present by raising a fold of skin 2}^ cm. high. In case of 
pronounced swelling in Viborg's triangle the operator must 
determine his location for operating by the position of the 
sterno-maxillaris muscle. Then force a passage with the 
finger [or with blunt scissors or other blunt instrument] 
through the loose connective tissue in the area which is free 
from nerves and vessels on the inner or median side of the 
parotid gland and of the stylo-maxillaris muscle to the gut- 
tural pouch and force a passage through it at its lowest 
point with the finger or a trocar. In order to open the 
empty guttural pouch it is desirable to grasp it by means of 
forceps. Through the operative wound a drainage tube 
can be introduced into the pouch, which can be fixed in its 



Openi7ig of the Guttural Pouches. 



19 



position and prevented from slip])ing in or out by suturing 
to the edges of tiie cutaneous wound, [In abscess of the 
sub-parotid h-mph glands the operation is identical with 




Fig. 9. — Head and neck of recumbent horse viewed from the side. 
Opening of the guttural pouches (Hyovertebrotomy) according 
to Viborg and Chabert. sm, Stylo-maxillaris muscle ; p, parotid 
gland ; /, guttural pouch ; k^ larynx ; st^ sterno-maxillaris muscle ; 
r, rectus capitus anticus major muscle ; c^ external carotid artery ; 
e, external maxillary artery ; i, internal maxillary artery ; v, ex- 
ternal maxillary vein ; s, probe ; a, wing of atlas. 

the foregoing only that the abscess has pushed the lateral 
wall of the pouch far inwards (medial) so that the pouch it- 
self is not opened nor reached.] 



20 Opening of the Guttural Pouches. 

2. Chaberfs method. Secure the horse in the lateral re- 
CLiinbsnt position, remove the hair and disinfect the skin 
beneath the wing of the atlas. Make an incision about i 
cm. in front of the lower half of the wing of the atlas and 
parallel to it, about 6 cm. long extending through the skin 
and skin muscle down to the parotid gland. The incision 
is facilitated by rendering the skin tense with the left hand 
and care is to be taken not to wound the auricular nerve 
which passes directly along the atlas. Then draw back- 
ward the posterior border of the wound and separate with 
blunt instruments the posterior border of the parotid gland 
from the atlas to which it is bound l)y loose connective 
tissue and draw the parotid gland forward with tenacula. 
At the bottom of the opening thus formed there is seen the 
stylo-maxillaris (digastricus) muscle lying against the 
median side of the parotid gland covered only by the 
aponeurosis of the mastoido-humeralis muscle. With the 
handle of the scalpel inclined toward the wing of the 
atlas penetrate in the direction of their fibers the aponeu- 
rotic expansion of the mastoido-humeralis muscle and the 
sterno maxillaris muscle. The puncture is thus located be- 
tween the ninth and tenth nerves on one side and the in- 
ternal carotid on the other. Since the wall of the guttural 
pouch rests against the median side of the digastricus mus- 
cle the pouch is opened by this incisior.. The operator in- 
serts an index finger along the blade of the knife at first 
and after withdrawal of the knife the other index finger 
also in the punctured wound and by forcibly parting these 
dilates it. The abnormal contents are then removed by 
means of forceps, curetting and irrigation. In order to pre- 
vent adhesion of the firmly stretched stylo-maxillaris mus- 
cle, introduce a strong drainage tube into the pouch and 
fix it to the external borders of the wound by a suture. 

3. Dieterich' s method. This combines the operations under 
I and 2, with the difference that the superior opening of the 
pouch is made immediatel)' behind the stylo-maxillaris. 



Tracheotoviy. 21 

111 order to accomplish this the cutaneous wound over the 
wingof the atlas must be prolonged below it. After detach- 
ing the posterior border of the parotid gland the operator 
searches in the loose areolar tissue with the index finger of 
the left hand for the vascular angle which is formed by the 
occipital, internal carotid and external carotid arteries which 
may be detected by pulsation— the same is located at a depth 
of somewhere from 8 to 10 cm. Place the volar surface of 
the finger in the vascular angle and push a sharp scalpel 
along the dorsal surface of the finger to the pouch which 
here becomes opened on its posterior lateral surface. 

This method has the advantage over Chabert's that for 
the removal of hard contents (chondroid) the opening can 
be readily dilated, even to such an extent that the entire 
hand can be passed into the air sac and the opening of the 
Eustachian tube be explored. 



TRACHEOTOMY. 
Fig. 10. 



histnwieiits. Razor, scissors, convex scalpel, tenacula, 
tenaculum and ligation forceps, trachea tube and suture 
material. 

Technique. In the superior third of the neck in the region 
of the fourth to the sixth tracheal ring shave and disinfect 
the skin on the anterior surface of the neck to the extent of 
10 cm. long b}^ 5 cm. wide. The operation can generally be 
performed upon the standing animal with the head extended. 
In lateral decubitus of the horse the operation is carried out 
with greater difficulty. The operator stands before the 
right, an assistant before the left shoulder of the horse. On 
the shaved area the operator and his assistant takes up a 
fold of skin 3 to 4 cm. high, transverse to the long axis of 
trachea, and divides the same by an incision. The 6 to 8 
cm. long skin wound then lies in the median line of the 
anterior face of the neck. After the skin muscle is cut 



22 Tracheotomy. 

through, ill order to avoid hemorrhage separate the two 
sterno-thyro-hyoideus muscles, by means of teiiacula, along 
the median line in the white strip of connective tissue. 

The trachea which is now laid bare is slit from below up- 
ward through thite or four tracheal rings if the operation is 
to be performed without loss of substance. By the method 




Fig. io. — Tracheotomy, s, Sterno-thyro-hyoidens muscle ; /, trachea ; 
sch, mucous membrane of the posterior wall of the trachea ; /, 
interannular ligament. 

with loss of substance penetrate at the lower angle of the 
wound, transversely, the lowest inter-annular ligament, 
elongate the incision to the right and left, make a vertical 
incision on each side upwards through one or two tracheal 
rings, grasp the partially detached portion of trachea with 
forceps and cut it out by means of an incision through the 
inter-annular ligament, which now constitutes the only- 
union with the trachea. According to the size of the 
trachea tube and the width of the tracheal rings one or two 
tracheal rings are removed. The outer canula of the tube is 
now introduced into the trachea directed upwards, the inner 
inserted through the first and screwed fast to this with the 
thumb screws. If the cutaneous incision is too long, occlu- 
sive sutures should be inserted through the skin above and 
below the trachea tube. 



Arytenoidrraphy . 23 

INTRA-TRACHEAIv IRRIGATION. 

[For dislodging septic or irritant substances from the trachea and 

bronchi.] 

lyistriunents. Same as for tracheotomy, and a gravity ir- 
rigating apparatus fitted with 3 m. of rubber tubing about 
I cm. diameter, 5 liters of .6 per cent, soda bicarbonate or 
chloride .solution at a temperature of 37 @ 39° C. 

Techniqite. Operate on standing animal. Perform tra- 
cheotomy. Elevate the gravity apparatus containing the 
irrigating fluid i to 2 m. above the patient, have the ani- 
mal's head slightly elevated, insert the free end of the rub- 
ber tubing in the trachea tube and let the fluid flow into the 
trachea in a moderate stream until it is filled and the animal 
makes explusive efforts, when the inflow is stopped and the 
animal permitted to lower his head and expel the fluid, then 
raise the head again and repeat until the fluid is expelled 
clear. Repeat the operation according to requirement. In 
cases of suppurative bronchitis, peroxide of hydrogen should 
be added to the solution. 



ARYTENOIDRRAPHY. 

[Merillat's operation for the cure of " Roaring."] 
" Fig. II, 12, and 13. 

Instruments. Scalpel, curved needle, strong suture of 
braided silk i m. long, retractors, long handled needle 
holder, long tenaculum, angular or curved scissors, and 
haemostatic forceps. 

Technique. Cast the patient and anaesthetize, and place 
and retain in the dorsal position with the head extended to 
the maximum on a straight line with the long axis of the 
body. 

ist. Make a longitudinal incision through the skin and 
underlying muscles from tlie base of the thyroid cartilage to 
the anterior margin of the first tracheal ring, dilate the 



24 



A ryte7ioidrraphy . 



wound with retractors and control all hemorrhage before 
proceeding further. . ^ 




Fig. II. — Median longitudinal section of the larynx, showing location 
of the ligature in arytenoidrraphy (diagrammatic), a, The left 
arytenoid cartilage ; b, left vocal cord ; c, cricoid cartilage ; c' , 
bezePof cricoid cartilage ; d, d' , tracheal rings ; e, epiglottis ; f, 
base of the thyroid cartilage ; f\ left ala of thyroid cartilage ; g, 
supraglottal sinus ; ^', dotted lines representing vocal process. 



A rytenoidrraphy 



25 



2iid. Laryngotomy. There is now exposed to view, from 
before backward, the crico-thyroidean membrane, the con- 
stricted portion of the cricoid cartilage, and the cnco- 




FiG. 12. — The third step of arytenoidrraphy (diagrammatic), a. Left 
arytenoid cartilage ; b, vocal cords ; r, the cricoid cartilage ; d^ 
the first tracheal segment. 



tracheal ligament. Pass a scalpel into the larynx through 
the crico-thyroidean membrane just behind the base of the 
thyroid with cutting edge directed backward and cut 

3 



26 



A ryteJioidrraphy . 



through the above named structures. The bleeding is 
again controlled and especially a small vein related to the 
anterior margin of the cricoid cartilage. 

3rd. The incision is now gently dilated with the retractors 
in order to inspect the laryngeal cavity. Forcible or even 
moderate traction with the retractors must be avoided so as 
to prevent unnecessary injury to the cricoid cartilage. (It 
is evident from recent observations that the injury done to 




Fig. 13. — Knot used in ligating arytenoid cartilage in arytenoidrraphy. 
a, First tie ; b, knot completed. 



the cricoid cartilage by forcible dilatation of the opening is 
frequently the actual cause of its collapse.) 

The threaded needle is now passed through the space be- 
tween the cricoid and thyroid cartilages, from without 
inward to a point just behind the vocal process of the 
arytenoid (Fig. 11) and is directed back to the point of 
entrance from a point just in front of the vocal process be- 
neath the vocal cord. Th^ arytenoid cartilage is now 
pressed against the lateral wall of the larynx while an 



Intravenous Injection. 27 

assistant draws the ligature tight and ties it by a knot con- 
sisting of two hitches, each of which is a bow and which 
can be completely loosened by pulling the cut ends (Fig. 13). 
If the ligature is tied by any of the ordinary knots it will 
be necessary to again cast the patient at the time of its 
removal ten days later. 

4tli. The parts around the ligature are now slightly 
wounded so that the resulting cicatrix will hold the aryte- 
noid cartilage in place after the ligature is removed. This 
wounding consists of an incision through the mucous mem- 
brane along the posterior border of the arytenoid and 
a resection of 2 cm. of the vocal cord beginning .5 cm. 
from the ligature. Return the patient to the lateral 
recumbent position to revive from the anaesthetic. No 
form of intubation or tamponing that will forcibly dilate the 
incision is admissible. 

After-care. Apply antiseptics to the superficial parts of 
the wound. In ten days the ligature is untied and gently 
pulled out. Alarming dyspnoea may occasionally occur 
from tumefaction of the laryngeal mucous membrane, at any 
time during the first four days following the operation. 
Usually this condition can be met by simply dilating the 
dermal incision by means of sutures passed through each 
edge of the wound and tied at the poll, but when this fails 
tracheotomy must be resorted to. It is never advisable to 
insert a tube through the original incision. 



INTRAVENOUS INJECTION. 
Fig. 14. 

histritments. Scissors, hypodermic syringe. 

Technique. The operation is performed on the standing 
horse on the right jugular vein at the juncture of the upper 
and middle thirds of the neck. At this place the subscapulo- 
hyo'ideus muscle lies between the jugular vein and the 



28 



hi travenoiis Injection . 



carotid artery. After clipping the hair, the skin should be 
carefully disinfected. The vein lies in the jugular groove 
between the mastoido-humeralis and the sterno-maxillaris 
muscles covered onl}^ by the skin and cervical panniculus 
carnosus muscle. The operator stands by the right shoulder 
of the horse and compresses the jugular with the thumb of 
the left hand (Fig. 14) or with second to fourth fingers of the 
left hand, in which case the ball of the thumb rests upon the 
mastoido-humeralis muscle, in such a way that the vein 
becomes filled above the point of compression in the shorn 




Fig. 14. — Intravenous injection. 



area so that it stands out like a swollen cord. In ca.se of 
fleshy necked hoises this compression is more readily 
attained if the animal's head is somewhat extended and 
elevated -b}^ an a.ssistant. If the vein cannot be made promi- 
nent in this way the compression should be alternated 
suddenly and repeatedly ; the course of the vein then reveals 
itself b}^ a wave-like movement which runs along the jugu- 
lar groove from above to below. Just above the point of 
compression the vein is most fully distended and is here also 



Venesection. 29 

most firmly fixed. After testing the hypodermic needle to 
see that it is open, insert it just above the point of compres- 
sion, through the skin, cutaneous muscle and jugular wall 
in tlie direction of the vein from behind and below, forwards 
and upwards i to 2 cm. deep, so that the point of the needle 
enters the vein at its most distended part. In this way it is 
easy to prevent injury to the median wall of the vein. The 
needle is held between the second and third fingers of the 
right hand while the thumb covers its posterior opening. 
If the vein has been properly punctured blood will flow 
from the needle upon the removal of the thumb. In this 
case the compression is removed, the left hand grasps the 
needle, the right connects the hypodermic .syringe, in which 
no air is contained, and slowly discharges the contents of 
the syringe. In withdrawing the needle be careful to press 
the skin firmly against the underlying part. The omission 
of this precaution frequentl}^ results in the formation of a 
subcutaneous extravasation of blood. If the vein is not 
entered at the first attempt the needle should be partly with- 
drawn and then pushed in again in a slightly different 
direction. 

For venesection a hollow needle 5 mm. in diameter is used. 



VENESECTION. 



Instrumeyits. Razor or scissors, fleams, lancet, phle- 
botomy trocar, spring lancet, pin, thread or suture material. 

Technique. I. Phlebotomy with fleams is performed on 
the left jugular vein with the horse standing. The point of 
operation is the boundary line between the upper and middle 
cervical regions, because it is here that the subscapulo- 
hyoideus muscle which separates the jugular vein from the 
carotid artery is most voluminous. At this point the skin 
is shaved or clipped and disinfected. The extended blade 
of the fleam is grasped at the joint with tlie thumb and 
index finger of the left hand, while the third and fourth 



30 VenesecHo7i. 

fingers of the left hand compress the jugular vein at a point 
far enough below the shaved part that the fleam blade rests 
upon it. In fleshy necked animals the course of the vein 
may be clearly made out by repeated distension and relaxa- 
tion of the vein. It is well to be careful that the point of 
the fleam blade is not allowed to prick the skin prematurely 
as it causes restlessness of the animal ; and that the fleam 
blade is held perpendicular and parallel to the axis of the 
vein. The most elevated point of the distended vein should 
be struck by the knife in such a way that the skin, subcu- 
taneous muscle and jugular wall are penetrated parallel to 
the axis of the vein. Drive the fleam blade into the vein by 
a short, sharp blow with the extended right hand or a light 
wooden stick. The extension on the fleam blade prevents 
its being driven too deeply. The size of the blade to be 
used depends upon the thickness of the skin, etc. If the 
vein is struck, dark red blood escapes from the wound in a 
large stream. I^ay the instrument aside with the right 
hand, while the fingers of the left hand continue the com- 
pression of the vein without interruption, in order to prevent 
aspiration of air into the vein, and also that the lips of the 
skin and vein wounds shall not become overlapped by 
which the escape of blood would be impeded. The escape 
of blood may be favored by inducing masticatory movements 
by the horse. The amount of blood to be withdrawn varies 
between three and four liters, according to the size of the 
animal and the object to be attained. The closure of the 
fleam wound is brought about either by an interrupted 
suture or a pin suture. For this purpose the compressing 
fingers of the left hand are relieved by the thumb of the 
right, the wound of the skin is grasped by the left index 
finger and thumb, the finger above, the thumb below, and 
the pin is stuck perpendicularly through the middle of the 
skin wound, a few mm. from the borders of the wound. 
Now that both hands are released a noose of silk thread pre- 
viously prepared is applied over the pin and the loop closed 



Venesection. 31 

and tied. In appl3nng the loop, care is to be taken to not 
elevate the skin from the underlying parts. If the operation 
does not succeed at the first effort, one should select an 
undamaged portion of skin for a second attempt. 

II. With the lancet the operation is performed on the 
right side of the neck. In both operations the operator 
stands near the horse's shoulder. The vein is compressed 
'as illustrated in Fig. 14. The lancet is held between the 
thumb and index finger of the right hand with the blade at 
right angles to the handle, the thumb and finger being so 
placed on the blade that the latter can barely penetrate the 
vein, and the instrument is then pushed in just in front of 
the left thumb through the skin subcutem and venous wall 
as deep as the fingers holding the lancet will permit. The 
blade must be held perpendicular to the axis of the vein, 
the point must not be directed backward (dorsalwards). 
The wound in the vein is then slit upward somewhat 
(toward the head) by dorsal flexion of the hand. In cattle 
the vein is compressed b}^ means of a cord tightly drawn 
around the neck, and the operator takes a position for his 
own safety and convenience beside the animal on the side 
where the operation is to be performed, while an assistant 
holds the animal by the horns, [or nose]. The closure of the 
phlebotomy wound occurs in a similar manner as in I., only 
with the modification that the thumb and second finger of 
the right hand grasps the cutaneous wound from before and 
the needle is pushed through the lips of the wound by the 
left hand with the aid of the right index finger. 

III. With the trocar the operation is performed in the 
same manner, as has been described for intravenous injec- 
tion. So long as the flow of blood continues the compres- 
sion of the vein must not l^e intermitted. 



32 



Ligation of the Carotid. 



LIGATION OF THE CAROTID. 

Figs. 15 and 16. 

Instriwients. Scissors, scalpels, tenacula, moiise-toothed 
forceps, ligation forceps, thread, suture material. 



4 1 







Fig. 15. — a, Ligation of the common carotid 
artery ; d, oesophagotomy. 



Tech7iiqice. The 
operation may be car- 
ried out with the ani- 
mal standing or cast. 
The operation is 
made at the s a m e 
point as for phleboto- 
my and the same 
cutaneous wound 
may be used for this 
purpose. The incis- 
ion should be at least 
10 cm. long extend- 
ing through the skin, 
the skin muscle and 
finally the subscap- 
ulo hyoideus muscle 
and then a passage 
forced with the fing- 
ers, with the cautious 
aid of the knife, to 
the trachea. At the 
juncture of the upper 
and middle thirds of 
the neck the carotid 
artery passes along 
the border between 
the lateral and dorsal 
surfaces of the tra- 
chea, accompanied 
dorsally by the vagus 



Ligation of the Carotid. 



33 



and sympathetic nerves and ventral l}- by the recurrent nerve. 
Pass the index finger over and behind the carotid until it rests 
upon the trachea encircling the inner and lower sides of the 
carotid, force a way through the surrounding tissue and 




Fig. i6. — Ligation of the common carotid artery, c. Common carotid 
artery ; 7, juglar vein ; v, vagus nerve ; r, recurrent nerve ; p, 
cervical panniculous carnosus muscle ; ;«, sterno-maxillaris 
muscle ; st, levator humeri muscle. 



draw the carotid out through the operation wound. As a 
rule the carotid is still surrounded by the lamellar fascia, 
which comes from the deep fascia of the neck in which also 
the three above mentioned nerves are found. After these 
have been carefully separated the carotid is ligated twice 
on account of its collateral anastomoses and severed in 



34 



CEsophagotomy. 



every case between the two ligatures. By this means we 
avoid rupture of the artery at the point of ligation where 
the nutrition has been cut off, through the stretching of the 
undivided carotid in movements of the neck. Drain and 
suture the skin and muscle wounds. 



CESOPHAGOTOMY. 

Figs. 15 and 17. 

Instriiments . Razor, scissors, convex scalpel, .straight 
probe pointed scalpel, tenacula, artery and ligation forceps, 
thread, absorbent cotton, suture material. 




Fig. 17. — CEsophagotomy. r, Common carotid artery ; 7, jugular 
vein ; o, o\ oesophagus ; s, sympathetic nerve ; t, trachea ; st, 
mastoido humeralis (lavator humeri) muscle. 

Technique. The operation can be carried out on the stand- 
ing or lying animal, on the left side of the neck, because the 



Qisophagotomy. 35 

oesophagus lies on the left side of the trachea in the lower 
half of the neck. When the oesophagus is empty the opera- 
tion is performed in the lower third of the neck. An incision 
10 cm. long through the skin and skin muscle is made be- 
tween the anterior border of the mastoido-humeralis muscle 
and jugular vein. With one finger each of the left and right 
hand divide the loose connective tissue down to the oesopha- 
gus, which lies between the left scalenus muscle, trachea and 
the jugular vein. Along the supero-external border of the 
trachea runs the carotid accompanied dorsall}- by the vagus 
and sympathetic and ventrally by the recurrent nerves. The 
oesophagus feels like a round muscle within which one can 
feel a firmer cord (mucous membrane), and has a pale red 
color. CEsophagus and trachea are surrounded by the deep 
fascia of the neck. Pass one finger around the oesophagus 
from behind, draw it away from the trachea, force through 
the deep fascia of the neck and draw the oesophagus out 
through the external wound. After making an incision 
through the muscle and mucous membrane introduce a 
probe pointed scalpel or a scissors blade into the lumen of 
the oesophagus and split its wall. The mucous membrane 
is white and lies in thick longitudinal folds. When there is 
a foreign bod}^ in the oesophagus the operation is performed 
at the point where it is lodged in the manner described and 
the oesophagus is opened barely enough to permit of the 
removal of the foreign body. In diverticuli of the oesopha- 
gus an elliptical piece of the mucous membrane which has 
been overstretched is cut out. The oesophageal wound is 
closed by a laminated suture, that is, the mucous membrane 
is united by means of an intestinal suture and the muscular 
wall sutured over this. The skin and nuLScular wound may 
either be left open or closed with the Bayer .suture and band- 
aged, with a drainage tube in the lower angle of the wound. 



OPERATIONS ON THE TRUNK AND GENITAL 

ORGANS. 

PUNCTURE OF THE CHEST. 

Fig. i8. 

Instrumeyits. Razor, scissors, chest trocar, vessel for re- 
ceiving the escaping fluid, dressing material. 

Technique. The operation is performed upon the stand- 
ing animal, which is held against a wall, the point of opera- 
tion being the seventh intercostal space on the left side, and 
the sixth on the right. Dogs ma}' be laid upon a table. 




Fig. 1 8, — Puncture of the thorax ; puncture of the intestine. 

The ribs are enumerated from behind forward counting 
eighteen to the horse and tliirteen to the dog. Clip or 
shave the hair and disinfect the skin immediately above the 
thoracic vein. Hold the trocar with the handle in the 
hollow of the right hand with the index finger on the instru- 
ment as in writing with a pen, sufficiently extended that 



Punchwe of the Intestines. 37 

the point of the trocar projects beyond it barely enough 
to penetrate the thoracic walls (4 to 6 cm). After the 
skin over the seat of operation has been drawn aside by the 
left hand place the trocar at the anterior border of the rib 
slightly inclined forward and push it with a sharp thrust 
through the skin, skin muscle, intercostal muscles, internal 
thoracic fascia and pleura into the pleural sac. As soon as 
the resistance ceases, the thoracic cavity has been entered. 
The stilette is now withdrawn and the existing fluid which 
may be pus, blood, serum, etc., escapes. While this escape 
is at first continuous, it later becomes rhythmic, synchro- 
nous with expiration. The intermission of the outflow 
during inspiration permits, wuth the ordinary trocar the en- 
trance of air into the chest cavity. This occurrence may be 
avoided by closing the canula with the finger after each ex- 
piration of the animal. The pneumothorax is best pre- 
vented by using Billroth's trocar. [The same result may 
be attained with an ordinary trocar by passing a piece of 
rubber tubing over the canula and dropping the free end in 
the vessel receiving the escaping liquid.] If the outflow 
becomes entirely interrupted introduce the stilette and re- 
move the occluding substance, usually fibrinous clots, from 
the canula. To remove the instrument, introduce the sti- 
lette into the canula, press the skin against the chest wall 
with the left hand and draw the trocar out promptly. As 
the displaced skin resumes its normal position the puncture 
is hermetically sealed. The outer opening may be covered 
with iodoform collodion. 



PUNCTURE OF THE INTESTINES. 

Fig. 18 and i8a.. 

Instrtivients. Razor, scissors, lancet, intestine trocar, 
dressing material. 

Technique. Puncture of the intestine is performed in the 



38 



Puncture of the hitesti7ies. 



right flank on the standing horse, lo cm. in front of the 
external angle of the ilinm and the same distance below the 
tranverse processes of the lumbar vetebrae, that is, at the 
most prominent part of the distension. After the skin at 
this place has been clipped or shaved, disinfected and dis- 
placed toward the external angle of the ilium, make a small 
puncture through the skin with a lancet and then with the 
trocar held in the hollow of the right hand push it with a 
strong thrust through the skin, tendinous expansion of the 
subcutaneous muscle, the external and internal oblique and 
transverse abdominal muscles, subperitoneal fat and perito- 
neum, in the direction of the elbow of the left side, enter- 




FiG. i8«. — Intestine trocar with sheath, 
3 mm., length of canula i6 cm. 



Outside diam. of canula 



ing the base of the caecum and introducing the trocar to the 
ring on the canula. After the withdrawal of the stilette the 
evacuation of the gas occurs at times intermittently owing 
to collapse of the intestine. Occlusion of the canula is to be 
overcome by introducing the stilette. 

When removing the trocar canula, in order to prevent the 
dropping of food particles out of the canula into the perito- 
neal cavity, replace the stilette, press the skin against the 
abdominal wall with the left hand and remove the trocar 
with a spiral motion. The external opening may be closed 
with iodoform collodion. [We very much prefer a much 
smaller trocar than is generally sold by dealers for the pur- 
pose, the canula being 3 mm. outside diameter by 16 cm. 
long. The triangular point of the stilet is much elongated 
(12 mm.) furnishing a cutting edge almost equal to a lancet, 
the incision with which latter is thus dispensed with, the 



Siibciitajieoiis Caudal Myotomy. . 39 

skin is not displaced, tlie trocar is held loosely by the canula 
ill the left hand and a smart blow strnck on the handle with 
the palm of the right hand driving the instrument through 
into the intestine. The wound being much smaller than 
with lancet, and closing at once, requires no after care.] 



SUBCUTANEOUS CAUDAL MYOTOMY. 

[Operation for Curved Tail.] 

Fig. 19. 

Instruments. Sharp straight tenotome, bandage. 

Technique. The point or points of curvature and their 
extent are to be carefully noted by having the animal|trotted 
away from the operator. The curvature is generally due to 




Fig. 19. — Transverse section of the tail. ;/, Caudal vertebra ; c, sacro- 
coccygeus lateralis muscle ; e, sacro-coccygeus superior ; /", de- 
pressor longus and brevis muscles (sacro-coccygeus inferior) ; i, 
intertranversales muscles ; a, cocc3'geal artery ; s^ supero-lateral 
coccygeal artery ; /, infero-lateral coccygeal artery ; v, caudal 
veins (dorsal, ventral, lateral) ; sch, caudal fascia ; h, skin. 

unequal development of the two levator or extensor muscles 
(Fig. 19^), though quite rarely the depressors (Fig. 19/) 
may be implicated. Confine the animal in stocks, or in 



40 Subcutaneous Caudal Myotomy. 

default of these, control b}^ means of twitch and sideline. 
Cleanse and disinfect the tail and have it sharply bent by 
an assistant in the opposite direction to the curvature. 
Locate the longitudinal furrow between the levator and 
depressor muscles and at the lower margin of the levator 
just above v, Fig. 19, insert the tenotome at the most promi- 
nent part of curvation, the incision being parallel to the 
muscular fibers, and push the tenotome entirely through the 
muscle to the vertebra, then turning the cutting edge up- 
wards, at the same time advancing the point of the tenotome 
toward the median line, sever the entire muscle. The 
superior lateral caudal artery 5, Fig. 19, bleeds profusely if 
severed, and wounding of it may usually be avoided by with- 
drawing the tenotome a trifle in passing that point. Wound- 
ing the skin over the muscular incision is avoided by placing 
the thumb of the left hand over the line of incision so the 
knife will be recognized as soon as the muscle and caudal 
fascia are cut through. Remove the knife in the same man- 
ner as introduced. Release the horse and have him trotted 
again. If the operation is sufficient tiie tail should curve 
in about the same degree as before, but in the opposite 
direction. If this has not been attained examine carefully 
and sever any remaining bundles of muscle, and this not 
sufficing repeat the operation as before at another point 5 or 
6 cm. above or below the first, severing the muscle again. 
Or if the depressor appears implicated, sever it in a similar 
manner. In extreme cases the entire lateral half of muscles, 
tendons and aponeurosis may be severed. Apply an anti- 
septic pad to the wound and retain it by a moderately firm 
bandage, which serves at once as an occlusive dressing and 
effective hemostatic. Remove bandage in 24 hours. 



Caudal Myectomy. 41 

CAUDAL MYECTOMY. 
[To prevent gripping of the reins]. 
Fig. 20. 

Instruments. Elastic ligature, straight bistoury, tenacula. 
absoFbent cotton, bandages, disinfecting material. 

Tecluiiqice. Confine the animal in lateral decubitis or in 
stocks, cleanse and disinfect the tail, apply the elastic liga- 
ture as close as possible to the root of the tail and have an 
assistant hold the tail extended upwards {i. e. dorsalwards) 
and tightly stretched. Make an incision 15 to 20 cm. long, 




Fig. 20. — Caudal myectomy. M, Depressor longus muscle. 

over the middle of the inferior surface of one depressor 
longus muscle, beginning close against the elastic ligature 
and extending toward the tail, severing at once the skin 
and caudal fascia down to the muscle. Let an assistant 
4 



42 Amputaiion of the Tail. 

dilate the incision with tenacula while the operator dissects 
the depressor longus mnscle from the adjacent tissues at 
either side when it is severed by a transverse incision close 
against the ligature and the entire muscle dissected away 
down to the lower end of the wound and there excised. 
The small depressor brevis, lying on the median side of the 
longus, should not be removed, thus preserving a limited de- 
pressor power. Repeat the operation on the opposite de- 
pressor. Make two elongated tampons of absorbent cotton, 
of the size and form of the muscles removed, saturate these 
in i-iooo sublimate solution, insert neatly in the wounds 
and apply a moderately firm bandage as closely as possible 
to the elastic ligature. Remove the ligature, upon which 
hemorrhage ensues, which is to be controlled by the appli- 
cation of a second bandage extending higher up on the tail 
over the previous location of the elastic ligature. Remove 
bandage in 24 hrs. wash the parts and saturate the tampons 
again with i-iooo sublimate and apply a clean bandage, 
allow it to remain for another 24 hrs. remove bandage and 
tampons and treat as an open wound. 



AMPUTATION OF THE TAIL. 
Fig. 19 and 21. 

Instriime?its. Docking shears, ring cautery iron. 

Technique. The operation is carried out on the standing 
animal with the aid of the twitch and one fore foot held up 
or side line applied to the hind feet. The point of amputa- 
tion is determined by the location of the disease or the 
wishes of the owner. At this point the hair is parted 
around the tail, turned upwards and bandaged to the root 
of the tail with a compression bandage (not a cord) which 
at the same time serves to make the operation bloodless. 
Then beneath the part clip the hair away for a space of 3 to 
4 cm. around the tail, have an assistant hold the tail hori- 



Amputation of the Tail. 



43 



zontall3^ stand at the side behind the left leg and apply the 
docking shears in such a way that the clipped portion of the 
dock rests in the semi-circular depression in the shears. By 
quick and powerful closing of the handles of the docking 




Fig. 21. — Amputation of the tail. /, Ivigature for binding the hair 
of the tail upwards. 



shears cut, if possible, between two caudal vertebrae at one 
.stroke the skin, the fibrous fascia of the tail, the donsally 
located levator, the ventrally located depressor, the curvator, 
the inter-transversales muscles with vessels and nerves, and 
the inter-articular cartilage. Grasp the .stump of the tail with 
the left hand and press the red-hot ring iron against the 
parts between the skin and vertebrae for from ten to twenty 
seconds in order to stop the hemorrhage so that a dry and 
firm necrotic scab covers the wound surface. In cattle and 
dogs the tail is amputated in a similar manner between two 



44 



U^'ethrotomy 



vertebrae ; a straight knife will answer for operating instru- 
ment. Hemorrhage is likewise most promptly controlled b}^ 
cautery. Ligating the arteries and applying bandage is 
more aesthetic. 



URETHROTOMY 



Fig. 22 and 23. 



bistrmneJits. Catheter, convex scalpel, scissors, artery 
and compression forceps, tenacula, lithotome, lithotomy 
forceps, lithotrite, absorbent cotton, drainage tube, suture 
material. 

Technique. Urethrotomy may be performed on horses 
in a standing position, the hind feet being secured with hob- 
bles. If this is not practical)le, the animal is carefully cast, 
after;the urinary bladder has been empted, if possible, and 




Fig. 22.— Urethrotomy at the ischial notch. 

by preference the animal should be p'aced in dorsal decu- 
bitis. The point of operation will depend on the location of 



Urethrotomy. 



45 



the calculus. If it is found in the pelvic portion of the 
urethra or in the blad ler, the operation is made at the ischial 
notch. First the penis is drawn out from the prepuce and 
the catheter introduced into the urethra and pushed upward 
until it has passed the ischial notch. After disinfection of 
the skin, render it tense and make a 5 cm. long in- 
cisibn in the median line at the ischial arch through the 
skin, bulbo-cavernosus muscle, spongy portion of the 




Fig. 23.— Urethrotomy ( life size), h. Skin ; a, retractor penis muscle ; 
b, bulbo-cavernous muscle ; c, spongy urethra ; ?^, urethra ; ^, 
catheter. 



urethra, and the urethral mucous membrane down to the 
catheter. In order to prevent infiltration of urine after the 
operation, special care is to be taken to make the lower end 
of the wound slanting in such a manner that the inner 
wound is shorter than the outer. After the catheter has 
been drawn back away from the ischial arch, introduce the 
lithotomy forceps into the urethra or bladder, grasp the 
stone and draw it outward \\\ its natural direction. The 



46 Ureth roto my . 

grasping of the stone by the forceps is materiall}^ aided by 
means of the left hand introduced in the rectum. One must 
avoid grasping, along with the stone, tiie mucous membrane 
of the bladder. By careful rotary movement and pushing 
the forceps backward and forward the operator can deter- 
mine before the extraction of the stone if the forceps can be 
withdrawn easily and without much resistance through the 
neck of the bladder. If the stone is so large that it cannot 
pass the neck of the bladder, lithotripsy must be performed. 
This operation requires time and patience, since as a rule it 
is not possible to encompass the entire calculus with the 
forceps. That is, the narrowness of the neck of the bladder 
prevents the sufficiently wide opening of the forceps. The 
stone must consequentlj- be gradually broken off at its peri- 
phery and the individual pieces of calculus removed. The 
character of the surface of the stone has an evident bearing 
upon the practicability of lithotripsy. When this operation 
is impossible, the operative dilation of the neck of the blad- 
der with the lithotome can be undertaken as a last resort. 
Introduce the instrument closed into the bladder, it is then 
opened and the neck of the bladder divided upward and 
laterally as the instrument is withdrawn. In order to pre- 
vent injury to the rectum it should be emptied before the 
operation is undertaken. After the removal of the stone, 
push the catheter again over the ischial arch and luiite the 
lips of the wound in the urethral mucous membrane by 
means of intestinal sutures. Flush the bladder or urethra 
by means of a warm 3 per cent, boric acid solution injected 
through the catheter and then withdraw the latter. Finally, 
suture the skin wound and insert the drainage tube or iodo- 
form gauze in the lower angle of the wound. [For student 
practice on an anaesthetized horse, introduce a stone into 
the bladder through the urethral wound and practice 
grasping and removing it with the lithotomy forceps.] 



Amputation of the Penis. 47 

AMPUTATION OF THE PENIS. 
Fig, 24. 
Instruments. Elastic ligature, strong silk thread, convex 
scalpel, artery and compression forceps. ^ ^ 




48 Vaginal Ovariectomy. 

Technique. The operation is carried out on the recumbent 
animal, the upper hind foot being released from the hobbles 
and drawn forward or otherwise so fixed as to not obstruct 
the field of operation. The point of operation is determined 
by the character of the disease of the penis and the object to 
be attained by the operation. If possible amputate in front 
of the preputial ring. After the penis is drawn out, and the 
preputial region is carefully cleansed with brush and soap, an 
assistant grasps the penis just behind the preputial opening 
with the hand and holds it firmly. A temporary elastic 
ligature is then applied in front of this hand around the 
penis and the organ excised by circular incision about 5 cm. 
in front of the elastic ligature or immediately in front of the 
preputial ring. The dorsal blood vessels of the penis are 
ligated separately. The urethra lying on the ventral side 
of the penis, and whicli is covered by the corpus cavernosum 
of the urethra, is dissected out of the urethral groove for a 
distance of about 2 cm., its dorsal wall slit and the mucous 
membrane sutured, spread out fan-like to the surrounding 
tissues. The urethra can also be slit dorsally and ventrally 
and the one half sutured to the left and the other to the 
right. A silk ligature is applied to the corpus cavernosum 
of the penis and the elastic ligature then removed. After a 
few da3rs the silk ligature is also removed. 



VAGINAL OVARIECTOMY. 

Figs. 25, 25a, 25b, and 26. 

histrimients. Colin's scalpel, ecraseur 55 cm. long. 

Techniqtie. Operate on the standing animal. Stocks are 
par excelleyice the proper means of restraint and are essential 
to the best results. In absence of stocks other means of 
restraint may be improvised. Secure the head elevated, 
prevent arching of the back or rearing, by a rope over the 
back, prevent lying down by two straps beneath the bod}^, 



Vaginal Ovariectomy. 



49 



and movements backward or forward h}^ ropes or straps 
behind and before the animal ; pinion all four feet and secure 
the tail tightly stretched upward to a beam. 




Fig. 25. — Vaginal ovariectomy. Diagrammatic sagittal section 
through dilated vagina of mare. A, Aorta ; R, rectum ; U, 
uterus ; V, vagina ; /, vaginal incision. 

With soap, water and brush cleanse the tail, perineum and 
vulva thoroughly, being especially careful to remove all 
detachable masses of sebum, 50 per cent, alcohol may be 
used .sparingly to aid in removing the sebum. Too free a 



50 



Vagiyial Ovariectomy . 



use of alcohol excoriates the delicate skin. Cleanse the 
clitoris carefully. Follow the washing with a free application 
of I : looo aqueous sublimate solution to the external parts 
and for a short distance (^ cm.) inside the vulvar lips and to 
the clitoris. Do not introduce disinfectants into the health}^ 




Fig. 26. — Vaginal ovariectomy. Diagrammatic horizontal section of 
uterus and dilated vagina. C, Clitoris ; 3f, urinary meatus ; V, 
vagina ; O U^ os uteri ; U, uterus ; (9, ovary. 



vagina nor deeply into the vulva as it will cause severe strain- 
ing during and subsequent to the operation and b}^ injuring 
the vulvo-vaginal mucosa favor subsequent infection of the 
vaginal wound. Wash away the sublimate solution with a 
tepid sterile .6 per cent, soda bicarbonate solution, and fill the 
vulvo-vaginal canal with the same. After thorough disin- 



Vaginal Ovariectomy. 51 

fectioii of the hands and arms remove the disinfectants by 
washing in sterile soda solution, which at the same time 
renders the hand unctuous and readily introduced through 
the vulva. Armed with the sterilized scalpel introduce the 
right hand into the vagina promptly and when the vagina 
is well " ballooned " unsheath the knife and placing it just 
above'the os uteri (I. Fig. 25) parallel to the long axis of 
the uterus and a few mm. to the right or left of the median 
line, the blade being held vertical, that is the cutting sur- 
face parallel to the longitudinal muscular fibers of the 
vagina, and guarding the possible extent of its introduction 
with the thumb and fingers, push it directly forward in a 
straight line with a quick thrust through vaginal mucosa, 
the muscular walls and the peritoneum until the disappear- 
ance of resistance indicates that the peritoneum has been 
penetrated. This is the most critical step in the operation. 
The vagina of the mare possesses the property of dilating 
in a remarkable manner like a balloon filled with air, occu- 
pying at such times practically the entire pelvic cavity, the 
rectum collapsed, and the roof of the vagina stretched firmly 
against the sacrum and in immediate contact with the great 
pelvic vessels, A Fig. 25, while at the sides and below the 
vaginal walls are generally in immediate contact with the 
bony walls of the pelvis. The roof of the vagina, when at 
rest, is in contact with the floor of the rectum and attached 
thereto by connective tissue until within 6 to 8 cm. of the os 
uteri where the two organs are separated b}^ a peritoneal 
duplicature which constitutes the operative area. This 
operative area, parallel to the rectum when the vagina is at 
rest becomes perpendicular to it when " ballooned " so that 
the operator needs to make his incision directly forward 
through a tense, thin, perpendicular wall like a drum head. 
There is in this state no operative area above whatever and 
an upward incision wounds the rectum and perhaps the 
posterior aorta or one of the iliac arteries. 

If the hand is introduced immediately after the injection 
of the sterile saline solution the vagina will generally be 



52 Vaginal Ovariedorny . 

found "ballooned" or will quickly become inflated under 
movements of the hand. If the solution is thrown out. the 
vagina may collapse and closely invest the hand, in which 
case more soda sohition should be injected when it will again 
dilate. If the hand is introduced without the knife, with- 
drawn and then introduced with the knife it will be frequently 
found that the vagina has collapsed and needs a second fill- 
ing with the fluid. Patience until dilation is accomplished 
and promptness to act when attained are prime requisites 
to success. The knife should be pushed through the vagina 
quickly making a clean wound the width of the knife blade, 
when the latter is to be withdrawn and laid aside. It should 
be remembered that in this " ballooned " state, the anterior 
wall of the vagina is but 2 to 3 mm. thick and easily pene- 
trated, the completion of the wound being indicated by the 
sudden disappearance of resistance. Introduce the hand 
again, insert one finger in the incision, then a second finger, 
and holding the fingers in the form of a cone push the entire 
hand into the peritoneal cavity. Immediately below the in- 
cision and continuous with the tissues involved in the wound 
lies the uterus with a transverse diameter of 4 to 6 cm. 
With the palmar surface of the hand downwards,, trace the 
uterus forward a distance of 15 to 18 cm., where it ends 
abruptly in two cornua of about the same size as the uterus, 
which are given off" horizontally at almost right angles. 
Trace these to right and left for a distance of 14 or 15 cm., 
where they end obtusely, and 3 or 4 cm. beyond this in a 
direct line, resting upon the anterior border of the broad 
ligament is the dense oval ovary varying in size from 2.5 to 
7 cm. in diameter. Withdrawing the hand, carry the 
ecraseur enclosed within the hand through the vaginal 
wound to the region of the ovary, release the ecraseur and 
retrace the parts if necessary, and locating the ovary drop 
the chain over the ovary from above and either grasp the 
ovary with the fingers through the chain loop from above 
and draw it into the loop or passing one or two fingers 
around beneath the ovary push it up through the loop to be 



Vaginal Ovariectomy . 



53 



grasped by the thumb and index finger above. The chain 
loop should be of barely sufficient size to admit of the easy 
passage of the ovary. Holding the ovary with the one hand 
tighten the chain quickly with the other, examine to make 
sure that a loop of intestine is not caught, draw the ovary 
well through and get a large portion of the oviduct, and cut 
off promptly, holding to the ovary until carried out through 
the vulva. Remove the other ovary in the same way. 
Generally it is most convenient to remove the left ovary 
with right hand and vice versa, but both may be removed 
with either hand. Wash away any blood from external 
parts, applv sublimate solution freely to vulva, perineum 
and tail. Keep the patient quiet for five or six days, and 
feed lightly on laxative diet. If infection occur mop out 
the vagina with antiseptics. If abscesses form open them 
promptly into the vagina or rectum by thrusting an index 
finger through their walls. If the infection causes difficult 
defecation by pressure on the rectum or swelling of its coats 
through inflammator}^ implication keep the feces pultaceous 
by means of enemas. 




JOHN REIYNDERS&CO. NEW YORK 




Fig. 25a. — Special spa5'ing ecraseur 55 cm. long. 




J REYNDERSaCO.NEWYORK- 



FlG. 25b. — Colin's scalpel. 



OPERATIONS ON THE EXTREMITIES. 

TENOTOMY OF THE FLEXOR PEDIS TENDON. 

Fig. 27. 

Instruments. Razor, scissors, sharp tenotome, bandage 
material. 

Techiiiqiie. Tenotomy is generally performed on the ten- 
don of the deep flexor of the foot or perforans, seldom on 
the superficial flexor or flexor of the os coronse of the ante- 
rior foot. The horse is -laid on that side upon which the 
affected foot is located and the member to be operated upon 
is bound upon a narrow board or extension splint of suffi- 
cient strength to retain the foot in complete extension. 
The median side of the foot is upward, the extending splint 
underneath. [With the operating table the extension splint 
is uncalled for.] On the median side at the middle of the 
metacarpus the skin is shaved and disinfected over the ten- 
don of the flexor pedis. The left hand grasps the meta- 
carpus from above and behind in such a manner that the 
thumb rests upon the median or upper surface of the meta- 
carpus, the index and second fingers on the lateral or under 
side of the flexor pedis tendon. While the left thumb 
pushes the skin toward the metacarpal bone, that is, for- 
ward, a sharp pointed tenotome held perpendicularly in the 
right hand is introduced with the cutting edge toward the 
hoof through the skin, subcutem and anti brachial fascia 
down to the flexor pedis tendon. Immediately on the ante- 
rior border of the tendon insert the tenotome so far that the 
point of it can be felt on the lateral or outer side through 
the skin with the left hand. The cutting edge of 
the knife is then turned against the tendon of the flexor 
pedis, that is, it is directed backward, the fore foot is ex- 
tended by an assistant by means of a rope bound around the 



Tenotomy of the Flexor Pedis Tendoii. 



55 



pastern and looped around the hoof, and the.'extensor pedis 
tendon is cut through under light pressure, by the operator 
pressing downward on the liandle of the knife. A loud 




crackling as well as the disappearance of resistance by ex- 
tension shows that the tendon is severed. In this way we 
can avoid injury to the common digital artery, the internal 
cutaneous vein and the internal and external interosseus 



56 Strbighalt Operation. 

veins which run between the flexor pedis and the suspen- 
sory ligament. After the removal of the knife and after 
seeing that there is a wide space between the ends of the 
tendons, the foot is unbound from the splint and the band- 
age applied to the metacarpus, which rests upon the fetlock 
joint and remains in position for eight days. Healhig of the 
cutaneous wound b}^ primary union. 



STRINGHALT OPERATION. 

[Tenotomy of the lateral extensor of the pedis.] 

Fig. 28. 

Instrjunents. Razor, scissors, sharp tenotome. 

Techiiqiie. On the lateral side of the metatarsus there is 
formed a triangle opening toward the tarsus formed by the 
tendons of the extensor pedis longus muscle and the lateral 
extensor of the foot which unite on the anterior surface in 
the middle of the metatarsus. The tendonous sheath of the 
extensor pedis longus muscle reaches toward the toe to near 
the point of juncture of the two tendons ; the sheath of the 
lateral extensor ends below 3 to 4 cm. above the point of 
union. In the middle of this space' witiiout a sheath, which 
is 3 to 4 cm. long, and below the annular ligament of the 
hock the operation is carried out, after the skin has been 
shaved and disinfected. The operation can be performed 
upon the standing horse, a twitch being applied and the 
hind foot being taken up as for shoeing. The tendon of 
the lateral extensor is easily felt under the skin as a hard 
cord about the size of the little finger. Stretch the skin 
and grasp the tendon with the thumb and index finger of 
the left hand, insert the sharp tenotome with the cutting 
edge toward the foot perpendicularly upon the tendon 
through the skin, subcutem and aponeurosis derived from 
the crural fascia ; push the knife from before backward 
under the tendon, direct the cutting edge of the teno- 
otome against it and with the hock extended sever the 



S// -1)10 11 a It ( ^pe } a tio n 



57 



tendon as well as the fascia Ihrongh to the skin. If the 
tendon has been completely severed its retracted ends may 




Fig. 28.— Stringhalt operation (tenotomy of the lateral extensor). 
Right hind foot seen from the external side. The skin covering 
the lateral extensor of the foot is laid back in the form of a flap, 
the crural fascia divided. <?, Tendon of the lateral extensor of 
the foot (peroneus) ; /, crural fascia; /, tendon of the anterior 
extensor pedis muscle ; d, the triangle formed by / and e. 

be felt under the .skin i to 2 cm. above and below the 
wound. After the operation an antiseptic bandage is ap- 
plied resting upon the fetlock. The bandage should re- 
main eight days and the cutaneous wound heal by first in- 
tention. 
5 



58 Cunean Tenotomy. 

CUNEAN TENOTOMY. 
Fig. 29. 
histruments. Razor, straight scalpel, tenotome. 




Fig. 29. — Cunean tenotomy. Tendon of the cunean branch of flexor 
metatarsi muscle exposed. 



Plantar Neiirectoviy. 59 

Technique. Most horses can be operated on standing, 
otherwise cast on the affected side and extend the tarsns. 
Shave and disinfect an area 5 to 6 cm. square on the inferior 
median surface of the hock over the course of the cunean 
tendon of the chief flexor of the metatarsus. Locate the 
tendon b\' palpation as it passes obHquely downward and 
backward and make a perpendicular incision at a point 
midway between the anterior and posterior borders of the 
hock or slightly anterior thereto about i cm. long, begin- 
ning at the lower border of the tendon and extending down- 
wards toward the foot. Insert the tenotome beneath the 
inferior border of the tendon and depressing the handle cut 
upwards and outwards through the tendon and fascia to the 
skin, or inserting the tenotome flatwise between the skin 
and tendon push it upwards to the superior border of the 
tendon, then turn the cutting edge of the tenotome toward 
the tendon and elevating the handle, using the superior 
border of the wound as a fulcrum, cut the tendon through 
from above downwards. By firm pressure upon the teno- 
tome in the latter method periosteotomy is simultaneously 
accomplished. The completion of the operation is evidenced 
by the retraction of the cut tendon leaving a well marked 
depression at the point of operation. Disinfect the wound, 
apply an aseptic bandage and allow to remain undisturbed 
for 6 days. Healing by primar}^ union. 



PLANTAR NEURECTOMY. 
Fig. 30. 

Instru7nents. Razor, scissors, convex scalpel, artery for- 
cep':, compression forceps, tenacula, needles, suture mate- 
real, elastic ligature. 

Technique. A bandage saturated with sublimate or 
creolin solution is applied to the fetlock joint of the horse 24 
hours before the operation, and the animal is cast in such a 



6o 



Plantar Neurectomy 




Big. 30. — Plantar neurectomy. a, 
Lateral digital artery ; i\ lateral digi- 
tal vein ; 11, common lateral digital 
nerve ; d, anterior branch ; o, pos- 
terior branch ; s, superficial flexor 
tendon ; p, perforans tendon ; z, sus- 
pensory ligament of fetlock ; ;//, 
metacarpus. 



manner that the median 
side of the foot to l)e oper- 
ated upon lies upward ; 
the nerve on the median 
side is operated on first 
[except when both feet 
are to be operated on 
at once, when the me- 
dian plantar on one foot 
and the external nerve 
on the other are cut in 
first position]. Bind the 
foot upon the extension 
splint and apply the elas- 
tic ligature above the 
carpus. [With the oper- 
ating table the extension 
splint is not required ; 
the operation is also read- 
ily performed on the 
standing animal with 
the aid ofcocaine.] After 
removal of the bandage, 
shave the site of oper- 
ation and thoroughly dis- 
infect the region of the 
metacarpus and fetlock 
with soap, brush, and 
sublimate or creolin solu- 
tion and 50 per cent, 
alcohol. Passing the 
fingers from before to 
behind with light pres- 
sure over the region of the 
fetlock joint, there is felt 
just in front of the flexor 



Plantar Neutcctomy. 6i 

pedis tendon a channel-like depression extending from above 
the fetlock downward over it. In this chann.el lies the thread- 
like cord of the nerve 3 mm. thick, which glides forward 
underneath the fingers with an audible, palpable recoil. 
The site of operation lies immediatel}- above the fetlock in 
the ^posterior third of the metacarpus. Here stretch the 
skin f^etween the index finger and thumb of the left hand and 
make a cutaneous incision between the thumb and finger 
directly over the nerve 3 to 5 cm. long, the lower angle of 
which lies imniediatel}- above the fetlock joint. The bor- 
ders of the cutaneous wound are held apart with tenacula 
and by palpation of the white subcutis with the fingers, it 
is determined if the nerve lies in the middle of the wound. 
If this be the case the subcutis is grasped with the forceps 
and carefully dissected by incisions parallel to the course 
of the nerve and the blood vessels, until the contour of the 
nerve is clearly brought out. [We prefer extending the in- 
cision directly upon the nerve without any tearing or pull- 
ing at the connective tissue by forceps or otherwise]. The 
nerve is distinguished by its yellowish color, its fine longi- 
tudinal fibers and its location behind the blood vessels. 
Immediately above the fetlock joint the median metacarpal 
or metatarsal nerve divides into an anterior smaller and 
posterior larger branch. This division must be laid bare in 
order that the operator should not erroneously cut one 
branch only. Immediately above this point of division the 
aneurism needle armed with the thread is passed under the 
nerve and the tliread tied in a single knot. The pressure 
of the thread upon the nerve causes severe struggling by 
the animal. The thread being held taut so that the nerve 
is drawn above the surrounding tissues insert one blade of 
the scissors or a small probe pointed bistoury beneath the 
nerve above the ligature and cut the nerve through quickly 
at the superior angle of the wound. The nerve is then dis- 
sected free as far as possible downward and both branches 
excised at the lower angle of the wound so that a section 3 



62 Digital Ne^irectomy . 

to 5 cm. long is removed. In front of the nerve lies the 
median metacarpal artery and in front of this the median 
metacarpal vein. Tiie cntaneous vvonnd is united by a con- 
tinuous suture and a temporary bandage applied. The ex- 
tension splint is then removed, the foot replaced in the 
hobble and the horse turned to the other side. Neurectomy 
of the lateral metacarpal nerve is carried out in the same 
way after which a sterile bandage is applied which is al- 
lowed to remain eight days. Healing by primary union. 



DIGITAL NEURECTOMY. 
Fig. 31- 

histrumetits . Razor, scalpel, probe pointed scalpel, te- 
nacula (2), aneurism needles (2), bandages. 

TecJiJiiqtie. Restraint of animal the same as for the plantar 
operation. Extending downwards from the fetlock joint 
toward the coronet, between the posterior border of the pha- 
langes and the deep flexor tendon there is a slight furrow at 
the posterior part of which, close to the external margin of the 
tendon, lies the median or principal digital nerve (the chief 
branch of the metacarpal or metatarsal) accompanied in 
front by the digital artery, in front of which lies the digital 
vein. Immediately behind the nerve and generally lying a 
trifle deeper, is quite commonly found a second venous trunk 
of considerable size. Near the middle of the first phalanx 
the nerve is crossed externall}^ in an oblique direction from 
above to below and from behind to before by a white liga- 
mentous band slightly broader than the nerve extending 
from the posterior region of the fetlock to the lateral cartilage 
of the pedal bone. This must not be mistaken for the nerve 
and need not be if it is remembered that the nerve is accom- 
panied on the same plane and in a like direction by the 
satellite artery and vein, the former being enclosed with the 
nerve in a fibrous sheath. Midwa}^ between the fetlock and 



Digital Neurectomy 



63 



coronet and over the groove between llie flexor pedis tendon 
and the phalanges shave and disinfect an area 4 lo 5 cm. 



I 




Fig. 31. — Digital (low plantar) neurectomy. V, vein; A, artery 

A^, nerve. 



64 Neurectomy of the Median Nerve. 

square. In the center of tliis area nt the anterior border of 
the flexor tendon, with the scalpel held perpendicular to the 
skin, make an incision from above downwards a distance of 
from 2 to 3 cm., cutting cleanly through the skin and sub- 
cutaneous fascia down upon the nerve. The incision is 
favored by tensing the skin between the thumb and index 
finger of the left hand, but care should be taken to not dis- 
place it backwards or forwards. Dilate the wound by pres- 
sure with the thumb and index finger or otherwise and care- 
fully incise longitudinally the fibrous sheath enveloping the 
nerve and artery. Pass an aneurism needle beneath the 
nerve, and follow with a second aneurism needle immediately 
beside the first. Draw the two apart, one toward the toe, 
the other toward the fetlock, and separate thereby the nerve 
from the surrounding tissues. Remove one aneurism needle, 
insert the probe pointed scalpel beneath the nerve, and di- 
vide it at the upper angle of the wound and excise a section 
of nerve 3 cm. long. Disinfect and i)andage with or with- 
out sutiu'ing wounds. Leave bandage in place 6 to 8 days. 



NRURECTOMY OF THE MEDIAN NERVE. 
Fig. 32. 

InstnimeJits. Razor, scissors, convex scalpel, artery and 
compression forceps, tenacula, aneurism needle, suture 
material. 

Techyiiqite. The operation is performed on the median 
surface of the humero-radial articulation on the recumbent 
horse after the affected foot has been removed from the hob- 
bles and bound upon the extension splint [or fully extended 
on the operating table]. The foot is drawn out firmly from 
the shoulder, inclined somewhat forward. The operator 
kneels between the neck and the forearm and, after the 
region of the elbow joint is washed with soap and water, 
.searches for the median nerve where it glides over the pos- 



Neiirectomy of the Median Nerve. 65 

terior part of the joint to disappear behind the radius. 
Shave the skin at this point, disinfect it with soap, sublimate 
or creolin solution and 50 per cent, alcohol. The nerve lies 
as a rule somewhat in front of the middle of the median side 
of the forearm [on a line with the postero-internal margin 
of the radius] and can be felt lying somewhat deeply about 




Fig. 32.— Median neurectomy. Median surface of thejight humero- 
radial articulation. a, Brachial artery; ;/, median nerve; z\ 
brachial vein ; /, antibrachial fascia ; />, sterno-aponeuroticus 
muscle. 

5 to 6 mm. in diameter. The position of the nerve varies 
with the different position of the forearm. In fat and fleshy 
horses the identification of the nerve is more difficult. The 
nerve can even be felt upon the standing animal, andTde- 
termined whether it will be difficult to find or not. With 



66 Neurectomy of the Median Nerve. 

the nerve lying between the thnnib and index finger of the 
left hand, stretch the snperposed skin and immediately upon 
the nerve and parallel to it make an incision 5 cm. long, 
first through the skin, then through the sterno-aponeuro- 
ticus muscle. Any hemorrhage from the skin, subcutis, or 
muscle, is checked. The tenacula are inserted in the lips 
of the wound, and these being drawn apart the white anti- 
brachial fascia is brought to view and a search is made 
with the index finger to determine if the nerve lies in the 
middle of the wound, the fascia is divided immediately over 
the nerve with the scalpel and an oval piece of it excised 
with the scissors. If much fatty tissue is found between the 
layers of fascia it may be teased out carefully with two pairs 
of forceps and cut awa}^ with the scissors. There now 
comes to view a delicate reddish colored fascia-like mem- 
brane, the nerve sheath, behind which a blue cord, the 
brachial vein, is visible, the latter being intimately con- 
nected with the nerve sheath. The vein lies mostly behind 
and beneath the nerve and projects out over the anterior 
border of the same. [The operator needs be careful not to 
prick this vein with tenacula, as the hemorrhage therefrom 
is exceedingl}' annoying during operation.] Still farther 
forward may be felt the pulsating brachial artery. Incise 
the nerve sheath carefully and divide it upward and down- 
ward with the .scissors, whereupon the yellowish and dis- 
tinctly fibrous nerve comes into plain view, or carefully part 
the nerve from the vein with the handle of the scalpel. 
Carry the aneurism needle beneath the nerve from behind 
forward and tie the thread around the nerve. The horse 
usually reacts by powerful struggles. Draw the thread 
firmly so that the nerve is lifted up and cut it through at 
the superior angle of the wound by a sudden clip with the 
scissors [or with the probe pointed scalpel]. After the peri- 
pheral end of the nerve has been laid bare to the lower 
angle of the wound, a distance of at least 3 cm., it is ex- 
cised. Tamponade the wound with dry iodoform gauze 



Neurectomy of the Ulnar Nerve. 67 

and approximate the skin with a cuiitiiiuous suture. The 
tampon and sutures remain from i to 2 days. Since the 
sensation of the lower part of tlie \^<g is also maintained by 
the deep branch of the ulnar nerve which below the carpus, 
covered by the tendon of the oblique flexor of the carpus, 
communicates with the lateral plantar nerve, neurectomy of 
the median nerve does not completely effect the desired end. 
In order to produce complete anaesthesia, therefore, from 
median neurectomy, it is necessary at the same time to 
perform ulnar neurectomy. (Compare follow^ing chapter.) 



NEURECTOMY OF THE ULNAR NERVE. 

Fig- 33- 

histruvients. Same as preceding. 

Techjiique. Above and behind the carpus there may be 
felt a groove between the external and the middle flexors of 
the carpus. At this point 10 cm. above the pisiform bone 
the skin is shaved and disinfected and an incision 6 cm long 
made through the skin and antibrachial fascia. This in- 
cision extends just outside the median line of the posterior 
surface of the radius in such a way that the superior angle 
of the wound is about i cm. farther outward than tlie lower. 
Beneath the fascia between the aforementioned muscles is 
seen the ulnar nerve, on the median or inner side of it the 
collateral ulnar vein and between the two and somewliat 
deeper the collateral ulnar artery. The nerve, about 3 mm. 
in diameter is picked up with the aneurism needle, severed 
at the upper and lower angles of the wound, the lips of the 
wound united by a continuous suture and a bandage ap- 
plied. Healing by first intention. This operation is, as 
has already been remarked, only carried out in connection 
with neurectoni}' of the median nerve. 



68 



Neurectomy of the Ulnar A^erve, 




Fig. 33. — Ulnar neurectomy. Right forearm seen from behind, e, 
External flexor of the carpus ; /", oblique (middle) flexor of the 
carpus ; a, collateral ulnar artery ; b, antibrachial fascia ; n, ulnar 
nerve. 



Boss/'s Double Xeurectoviy for Spavin. 69 

BOSvSrS DOUBLE NBURKCTOMY FOR SPAVIN. 

I. NEURECTOMY OF THE POSTICRIOR TIBIAL NERVE. 

Instrinncnts. As in preceding. 

Tecjuiique. The opeiation is performed on the recumbent 
horse on llie innei side of the leg 10 cm. above the summit 
of the OS calcis. The upper foot is bound forward hy means 




Fig. 34.— Sciatic neurectomy. Right hind leg viewed from the median 
side. /. Crural fascia ; ;/, sciatic i tibial 1 nerve ; :-. plantar vein. 

of a side Hue [or with the operating table the upper foot is 
secured in tlie advanced position]. Tiie tibial (sciatic) 
nerve is tlien souglit for by grasping the leg with the left 



yo Bossi's Doud/e Neurectomy for Spavin. 

hand from behind in sucli a manner that the thumb rests 
above and the forefingers below the leg. Reaching forwsrd 
with the fingers to the deep flexor of the foot grasp the leg 
with moderate firmness and draw the hand slowly backward. 
Immediately behind the perforans muscle and between this 
and the tendo- Achilles the nerve nearly i cm. in diameter 
glides away forward from between the fingers with a pal- 
pable and audible recoil. If the nerve can not be found in 
this manner the hock should be strongly extended, by which 
means the nerve is caused to recede from the perforans 
muscle, so that it can readily be felt near the middle of the 
groove extending between the tendo Achilles and perforans 
muscle. At this point the skin is shaved, disinfected and 
an incision made through it 5 cm. long, parallel tothetendo- 
Achilles. The white rigidly-stretched crural fascia is now 
divided in the same direction after which it should be deter- 
mined by palpation that the nerve lies in the middle of the 
wound, excise with the scissors an elliptic or oval piece of 
the fascia or hold apart the fascia along with the lips of the 
cutaneous wound by means of the tenacula. In poor horses 
the contour of the nerve covered only by loose connective 
tissue stand out prominentl}^ in fat horses the nerve is sur- 
rounded by a large amount of adipose tissue. After this fat 
and connective tissue has been grasped with forceps it may 
be excised. The tibial nerve is now in sight, immediately 
before it lies the plantar vein and on the lateral side (be- 
neath the nerve as the animal lies) is situated the recurrent 
tibial artery ; separate these completely from the nerve with 
the handle of the scalpel, pass the aneurism needle from be- 
fore backward beneath the nerve and cut it off" at the upper 
and lower angles of the wound removing a section of nerve 
at least 5 cm. long. Suture the cutaneous wound aud apply 
a bandage allowing it to remain eight days. Healing by 
first intention. 



Bossi's Double Netwectomy for Spavhi. 71 

II. ANTERIOR TIBIAL NEURECTOMY. 

[Neurectomy of the Deep Branch of the Peroneal Nerve.] 

Fig. 35. 

Instruments. As in preceding. 

Techniqjie. Confine as in preceding with affected leg 
uppermost. Locate the furrow dividing the extensor pedis 
longus and lateralis ( peroneus) muscles and shave and disin- 
fect the skin over an area 6 cm. long by 3 cm. wide directly 
over this depression and extending upw^ard from a point 
6 or 7 cm. above the tibio-astragaloid articulation. 

At a point 8 to 10 cm. above the flexure of the hock make 
an incision 5 or 6 cm. long over the line of division between 
the two extensors of the foot, through the skin, the tibial 
aponeurosis and the special aponeurosis enveloping the ex- 
tensors. Superficially the operator passes near by the 
cutaneous division .of the anterior tibial nerve. Separating 
the two muscles for their entire thickness there is found 
lying deeply 3 to 6 cm. from the surface, and accompanied 
by a small artery and vein, immediatel}' against the flexor 
metatarsi magnus, the deep lying branch of the peroneal 
nerve. Pass the aneurism needle beneath it and remove a 
piece 3 to 4 cm. long. Close the cutaneous wound with in- 
terrupted sutures and dress antiseptically without bandage. 
This operation is performed only in connection with the 
preceding and for the same purpose as ulnar, with median 
neurectomy, 2. e., to complete the anaesthesia of the tarso- 
metatarsal parts. 



72 



Bossi's Double A^eitredomy foi- Spavin, 



''^f-j'-mtA 




¥' 




N 



^^s^^ 



Fig. 35. — Anterior tibial (peroneal) neurectomy, P, Peroneus muscle ; 
E, extensor pedis longus muscle ; tV, deep branch of the peroneal 
nerve. 



Resection of tJic Lateral Cartilage. 73 

RESECTION OF THE LATERAL CARTILAGE. 

(Ouittor Operation.) 
Fig. 36 and 37. 

histruvients. Elastic bandage, drawing knife, scissors, 
razor, hoof plane, tooth splinter forceps or other heavy 
forceps for the removal of the horn, artery forceps, double- 
edged sage knife, curette, needle holder, thread, needles, 
iodoform ether, iodoform gauze, tampons, absorbent cotton, 
bandages. 

Technique. A few hours before the operation the affected 
foot of the horse is placed in a bath of creolin .solution after 
having first made a semicircular groove in the horn of the 
lateral wall and quarter down to the horny lamina. The 
operation is i)erformed upon the recumbent anaesthetized 
animal, in such a position that the diseased cartilage of the 
affected foot lies upwards. After the application of the 
elastic bandage the groove in the horn is deepened with the 
drawing knife down to the .sensitive laminae without injuring 
them. The groove must be .so located that it reaches the 
anterior end of the lateral cartilage, remaining a few cm. 
di.stant from the bearing surface of the wall and .so that the 
lower semicircular border approaches the .sensitive laminae 
abruptly. The hair on the coronary band is clipped or 
shaved and the entire foot up to the fetlock joint thoroughly 
cleansed wnth brush, soap, creolin or sublimate solution and 
50 per cent, alcohol. The levator is then inserted beneath 
the lowest part of the semicircular piece of horn wjiich has 
been isolated, the horn is elevated from the sensitive struct- 
ures somewhat, grasped with the splinter forceps and care- 
fully loosened from the sensitive laminae by drawing upward 
in the direction of the lamina and by drawing backward 
from the coronary papillae and keraphyllous tissue. After 
the coronary- band has been smoothed with the scissors, 
make two perpendicular incisions through the skin of the 
coronary band and the coronary band itself, one behind the 
6 



74 



Resection of the Lateral Cartilage 



anterior and the other in front of the posterior border of the 
groove in the horn and connect the two b}' means of a semi- 




FiG. 36. — Resection of the lateral pedal cartilage. Horny wall re- 
moved , sensitive laminae and cutaneous flap held upwards. Posteri- 
or half of the cartilage excised. /, Sensitive laminse ; Z£/, coronary 
band ; k, anterior half of cartilage ; h, cavity caused by the re- 
moval of the posterior half of the cartilage ; n, necrotic cartilage ; 
/>, parachondral surface of the skin and sensitive laminae ; s, per- 
pendicular, crescent-shaped incision in the horny wall ; g, fistula. 

circular incision in the sensitive laminae. This U-shaped 
incision must be so made that between it and the horny wall 



Resection of the Lateral Cartilage. 



75 



there is left an area of sensitive laniince at least 2 cm. wide. 
The isolated flap is now dissected closely against the os pedis 
and its ala and later from the lateral surface of the carti- 
lage, the operator first lifting the flap with i)incers, later 
with the left hand. Above the cartilage toward the fetlock 




Fig. 37. — Resection of lateral cartilages. Completed operation 
( sutures ) . 



the operator must keep the fingers of the left hand against 
the external skin in order to avoid cutting through it or 
thinning it too much at this point. The flap is held 
turned upwards by an assistant. As a rule there is now 
seen a prominent greenish colored necrotic piece of cartilage 
surrounded by brownish red masses of granulations. By 
means of an incision through the cartilage parallel to the 



76 Resection of the Lateral Cartilage. 

axis of the foot, divide the cartilage into. anterior and pos- 
terior halves and extirpate the latter first, by dissecting it 
out on the outer and inner side from the parachondral tissue 
with the double-edged sage knife. The point of the sage 
knife must be constantly directed against the cartilage. 
Since the inner surface of the anterior half of the cartilage 
lies immediately against the capsular ligament of the corono- 
pedal articulation the latter should be sharply extended by 
which means the capsular ligament is drawn away from the 
cartilage before its extirpation. The anterior half of the 
cartilage is then removed in the same way, except with 
the greatest possible care. Remnants of cartilage and 
granulations are to be removed with the curette. Tlien 
cut away with the scissors and knife any remnants of 
cartilage adherent to the flap, thin if necessary the entire 
flap and excise the fistulous openings. After thorough 
disinfection of the entire field of operation return the flap to 
its former position and retain it there by a sufficient num- 
ber of interrupted sutures, irrigate the wound surface with 
iodoform ether and cover the parts over with iodoform 
gauze and tampons which rest firmly upon the perpendicular 
wall of horn. Finally invest the hoof and pastern up to the 
fetlock joint with oakum and lay a muslin bandage over it, 
the turns of which must extend from above downward. 
The bandage is protected by means of a leather shoe or 
pieces of sacking and the elastic bandage removed. If the 
animal is tree from fever, feels well and eats well, the 
bandage is left in position from 12 to 14 days. Healing by 
first intention. 



Resection of the Flexor Pedis Tendon. 



11 



RESECTION OK THE FLEXOR PEDIS TENDON. 

Instninients. Elastic bandage, drawing knife, doul)le- 
edged sage knife, scissors, tenaculum forceps, curette, 
l^andage material. 

Technique. Before the operation the horn of the sole, the 
frog and the bars are thinned down until the soft parts can 
be seen through them and an antiseptic bandage applied 
saturated with creolin solution. Cast the horse [or confine 
on operating table] chloroform and bind the foot to be oper- 




FiG. 38. — Resection of the flexor pedis tendon. vSolar surface of the 
foot, r, Semilunar crest of os pedis ; «, os pedis ; r, navicular- 
pedal ligament ; 5, navicular bone ; b, flexor pedis tendon ; e, 
sensitive lamintt of the bars ; st, fatty frog ; /, sensitive frog ; 
/f, horny frog. 

ated upon to the foot diagonal to it, [or on the operating 
table secure it firmly] apply the elastic bandage to the foot 
and carefully disinfect the hoof with soap, brush, creolin 
or sublimate solution and 50 per cent, alcohol. Then make 



UrfCi 



78 Resection of the Flexor Pedis Tendon. 

a transverse incision tiirough the base of the frog 2 to 3 cm. 
from the balls through the horny frog, the sensitive frog, 
and the fatty cushion down to the flexor pedis tendon. 
Follow this by two curved incisions extending forward and 
inward in an oblique direction corresponding to the semi- 
lunar crest of the os pedis, the line of incision being- about Yq, 
cm. outward from the lateral groove of the frog and uniting 
at the apex of the frog. This triangular piece of frog which 
has been isolated by the incision is now grasped with the 
pincers and dissected away. As a general rule the operator 
finds that he has not yet reached the flexor pedis tendon 
but only the fatty cushion which covers the latter. The 
remnants of the fatty frog should be removed with the 
double-edged sage knife by means of a horizontal incision, 
and there is then seen the greenish or yellowish colored 
necrotic flexor pedis tendon which may at times be covered 
with reddish colored granulations. vShould the operation be 
indicated on account of a suppurative pododermatitis the bars 
on the affected side must be excised along with the other 
portions. The position and extent of the navicular bone 
can be determined by feeling through the flexor tendon. A 
transverse incision is then made over the middle of the 
navicular bone through the flexor pedis tendon to the bene, 
the lower end of the tendon is grasped with the tenaculum 
forceps and lifted up from the navicular bone with the aid 
of two lateral curved incisions. Between the inferior 
border of the navicular bone and the semilunar crest of the 
OS pedis stretches the capsular ligament of the inferior 
articulation of the navicular bone and os pedis reinforced 
by dense fibrous bands. The flexor pedis tendon is united 
to this by a few bundles of fibres. Dissect the tendon care- 
fully away from the capsular ligament and beyond from the 
semilunar crest of the os pedis. If necrotic or discolored 
pieces of the fatty cushion or the tendon still remain, remove 
the.se with scissors, scalpel or curette. With the latter 
curette the roughened cartilage of the navicular bone and 



Amputatio7i of tlic Cla^vs in Cattle. 79 

remove necrotic portions of hone. In extensive necrosis of 
the suspensory ligaments of the heel and of the ligaments 
extending from the fetlock joints to the lateral cartilage the 
necrotic ligament as well as the neighboring fatty cushion 
with its numerous elastic fil)ers, must be resected. Disin- 
fect the operation wound, irrigate with iodoform ether and 
tanfponade it with dry iodoform gauze. Over this apply a 
firm pad of oakum, enclose the entire hoof up to the fetlock 
in oakum and apply over this a bandage. Over the band- 
age apply a leather shoe or heavy canvas and remove the 
elastic bandage. In the absence of fever the bandage 
remains in position for eight days. 



AMPUTATION OF THE CLAWS IN CATTLE. 
Figs. 39 and 40. 

histriiments. Half round rasp, double edged sage knife, 
scissors, convex scalpel, artery forceps, drawing knife, 
elastic bandage. 




Fig. 39. — Amputation of the claws of cattle, d, Horny wall, rasped 
thin ; g, articular condyle of 2nd phalanx ; a, b, c, course of in- 
cision. 



8o 



Afupiitation of the Claivs in Cattle. 



Technique. Cast the animal and secure the foot to be 
operated upon in an extended position, apply the elastic 
bandage after disinfecting the claws with soap and brush 
and creolin solution, rasp away the horn on the lateral side 
of the diseased claw, especially at the posterior part of it, 




Fig. 40. — Amputation of the lateral claw of cattle. Median claw pre- 
served. Viewed from the solar surface outward, a, External 
corono-pedal ligament ; /, internal do ; k, tendon of the flexor 
pedis muscle ; g, distal articular surface of the 2nd digit ; g^ , 
articular surface of 3rd digit ; g'\ navicular bone ; /, lateral claw ; 
in, median claw ; b, bulb of the heel. 



until the horny wall becomes so thin that it can be readily 
pressed in with the fingers. The corono pedal articulation 
can be felt, about 3 cm. below the coronary band, by 
grasping the claw with the left hand in .<-uch a manner that 



A))iputation of the Claivs i)i Cattle. 8i 

the thumb rests upon the thinly rasped horn while with the 
other hand the claw is moved from side to side. At the 
lowest point of the articulation push the double-edged sage 
knife into the joint, the cavit}^ of the knife being directed 
toward the fetlock, and make in the joint a curved incision 
at first forward and upward to the neighborhood of the coro- 
nary band then wntli strong flexion of the foot a second 
curved incision backward and upward which, however, ex- 
tends only to the navicular bone. B}' this incision the 
operator divides the horn, the sensitive lamina, the external 
corono-pedal ligament and the capsular ligament of the 
corono-pedal articulation. Pass the knife between the 
navicular and pedal bones and extend the incision down- 
wards perpendicular to the solar surface to the sole, sepa- 
rating the navicular bone from the os pedis. In this 
manner the navicular bone is preserved as well as the ball 
of the heel, the latter of which is of special significance in 
healing. The inner wall of the claw with the powerfully 
developed corono-pedal ligament is divided from before 
backward. After the vessels which can be seen are ligated 
the articular surfaces of the navicular and coronary bones 
curetted and the necrotic remnants of tendon removed an 
antiseptic bandage, preferably of tar, is applied and a 
leather shoe or canvas covering placed over it for protection. 
The bandage remains for 12 or 14 days. 



APPENDIX. 

THE BAYER SUTURE. 

Fig. 41 and 42. 

Instrumerits . i. lyarge curved suture needle armed with 
a strong silk thread, about 20 cm. long, which is doubled 
and passed through the e3'e in such a manner that the 
closed end extends considerabh- beyond the open ends. 




Fig. 41. — Retention, and continuous approximation sutures, d^ d' d^^ , 
Drainage tubes ; <f, retention suture (closed end) ; e^ , open end ; 
b, fixation suture for the drainage tube ; f, continuous approxi- 
mation suture. 

2. Small needles and thread. 3. Needle forceps. 4. 
Drainage tubing preferably two very large and one small 
with lateral openings. 5. Thin wooden splints 15 cm. long. 



Th e Baj} 'er Su tu re . 



83 



3 to 4 cm. wide, with rounded ends. 6. Iodoform gauze. 
7. Iodoform ether i : 10. 

Technique. After the skin has been shaved over an area 
having a radius of 5 to 6 cm. from the wound, the suture 
needle is inserted 2 to 3 cm. from the lips of the wound 
through the skin and subjacent tissues, a strong drainage 
tube;(t/') passed through the clo.sed end of the suture and 
the thread drawn tight. The needle is then pas.sed through 




Fig. 42, — Splint bandage, d, d' , d'\ Drainage tubes ; <?, retention 
suture];, (closed end); e^ , do, open end; 7, iodoform gauze ; 5, 
splints. 



the opposite lip of the wound from within to without at the 
same distance from the lips of the wound, the .second large 
drainage tube {d'') is laid between the open ends of the 
double silk thread and these are tied upon the drainage 
tube with a triple knot, after the}' have been drawn 
sufficiently tight that the approximated wound lips form a 



84 The Bayer Suhire. 

crest. If the lips of the wound can be grasped with the 
hand and held together in such a manner as to form a ridge 
3 or 4 cm. high, the suture needle can be passed through 
both lips of the wound simultaneously. The first suture 
should be located about 3 cm. beneath the upper angle of 
the wound, the other retention sutures follow at distances of 
about 5 cm. from each other and are applied in the same 
way. The lips of the wound are united by continuous 
approximation sutures like an overcasted seam. This suture 
ends at least 2 cm. above the lower angle of the wound. 
The third drainage tube is introduced into the latter and 
fixed by a special suture. The entire cutaneous surface 
lying between the drainage tubes is covered with iodoform 
gauze, and between each iwo retention sutures there is laid 
over this gauze the wooden splints previously cut to the 
proper size, the ends of which are shoved under the tubing. 
The upper and lowermost splints must be bound to the 
drainage tubing by means of sutures passed through the 
tubing. The entire bandage is finally saturated with iodo- 
form ether. The bandage and retention sutures remain 
eight days, the approximation sutures fourteen days. 



3£P6- mc 



